Impact of associated conditions on glycemic control of NIDDM patients

The Association of Dysglycaemia and Cardiovascular Disease in Patients with Metabolic Syndrome

The objective of this study was to investigate the relationship between increased prevalence of cardiovascular disease and glucose regulation status in Chinese patients with metabolic syndrome (MetS). All patients underwent an oral glucose tolerance test (2-h post-load plasma glucose) to determine their glucose regulation status and had their brachial–ankle pulse wave velocity (baPWV) measured. Of the 590 patients included in the study, 115 (19.5%) had normal glucose tolerance, 114 (19.3%) had impaired fasting glucose (IFG) alone, 38 (6.4%) had impaired glucose tolerance (IGT) alone, 197 (33.4%) had diabetes mellitus and 126 (21.4%) had combined glucose intolerance (CGI; IFG plus IGT). Patients with diabetes mellitus had a significantly higher baPWV compared with all other groups and patients with CGI had a significantly higher baPWW compared with patients with IFG. Dysglycaemia was common in patients with MetS. An increased prevalence of cardiovascular disease in patients with MetS was related to their glucose regulation status.

Effects of insulin, glimepiride and combination therapy of insulin and metformin on blood sugar and lipid profile of NIDDM patients

In the present study the efficacies of therapy with insulin, sulphonylurea or insulin + metformin on NIDDM patients are compared. One group which was on a definite dose of insulin therapy, but with uncontrolled diabetes was treated by doubling the insulin dose, a second group whose diabetes was not controlled by glibenclamide was switched over to another sulphonylurea viz; glimepiride and a third group whose diabetes was not controlled by insulin therapy was switched over to a combination therapy with insulin +metformin. After recording their initial blood parameters all the groups were treated as above for 3 months, and the parameters were again determined. The fasting blood sugar and serum lipids of the first group were controlled significantly, but the values were far above normal range. However HDL Cholesterol and atherogenic index were near normal range. In glimepiride treated group, none of the parameters showed any amelioration. In the combined therapy group, control of blood sugar and atherogenic index was more or less the same as for group 1, but hyperlipidemia remained slightly above that of the same. From the findings we can infer that in long term diabetes treatment higher doses of insulin and combined therapy with insulin and metformin may be more beneficial than with low doses of insulin or sulfonyl urea alone.

Pro12Ala polymorphism of the peroxisome proliferator-activated receptor-gamma2 (PPARgamma-2) gene is associated with greater insulin sensitivity and decreased risk of type 2 diabetes in an Iranian population

BACKGROUND

The Pro12Ala polymorphism of the peroxisome proliferator-activated receptor-gamma2 (PPARgamma-2) gene has been variably associated with insulin resistance, obesity and type 2 diabetes in several populations. However, this association has not been studied in Iranian subjects and we hypothesized that this variation might be associated with insulin resistance, type 2 diabetes and related metabolic traits in this population.

METHODS

The Pro12Ala genotypes were determined by PCR-restriction fragment length polymorphism in 696 unrelated subjects including 412 non-diabetic controls and 284 type 2 diabetic patients.

RESULTS

The frequency of the Ala allele was 9.4% and 5.9% in controls and type 2 diabetic subjects, respectively [adjusted odds ratio (OR) 0.457, p=0.005]. The Ala allele did not show a significant effect on anthropometric and biochemical parameters in the type 2 diabetic group, whereas in non-diabetic subjects, carriers of the Ala allele had significantly lower fasting insulin (p=0.007) and homeostasis model assessment of insulin resistance (HOMA-IR) (p=0.009) levels compared to Pro/Pro subjects. Multivariate logistic regression analysis showed that Pro12Ala polymorphism was an independent determinant of type 2 diabetes in this population.

CONCLUSIONS

Our results for a sample of Iranian type 2 diabetes cases and controls provide evidence that the Pro/Ala genotype of the PPARgamma-2 gene is associated with insulin sensitivity and may also have protective role against type 2 diabetes.

The metabolic syndrome is a risk indicator of microvascular and macrovascular complications in diabetes: results from Metascreen, a multicenter diabetes clinic-based survey

OBJECTIVE

We aimed at assessing the degree of association and the predictive power of the metabolic syndrome with regard to clinically detectable complications in patients with diabetes.

RESEARCH DESIGN AND METHODS

Metascreen is a cross-sectional survey of metabolic syndrome and clinically detected diabetes complications performed in 8,497 patients (7,859 with type 2 diabetes and 638 with type 1 diabetes) randomly chosen in 176 diabetes outpatient clinics throughout Italy. The metabolic syndrome was defined according to either the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) or the International Diabetes Federation (IDF) diagnostic criteria. Multivariate analyses of the association(s) between either AHA/NHLBI or IDF metabolic syndrome and clinical complications were performed. Receiver-operator characteristic (ROC) curves were constructed to compare the predictive power of the two sets of diagnostic criteria of the metabolic syndrome.

RESULTS

Either definition of the metabolic syndrome was an independent statistical indicator of the presence of nephropathy and neuropathy (P < 0.02-0.01) in type 1 diabetes and of all complications (P < 0.0001), including cardiovascular disease and retinopathy, in type 2 diabetes. For each complication, the ROC curves based on either AHA/NHLBI or IDF metabolic syndrome were similar to each other and to the ROC curves constructed with all continuous traits compounding the metabolic syndrome.

CONCLUSIONS

The metabolic syndrome, defined according to AHA/NHLBI or IDF diagnostic criteria, is an independent clinical indicator and may be involved in the pathogenesis of both macro- and microvascular complications of diabetes.

[Blood glucose control in diabetes patients seen in primary health care centers]

OBJECTIVE

To identify factors associated to poor glycemic control among diabetic patients seen at primary health care centers.

METHODS

A cross-sectional study was carried out in a sample of 372 diabetic patients attending 32 primary health care centers in southern Brazil. Data on three hierarchical levels of health unit infrastructure, medical care and patient characteristics were collected.

RESULTS

The frequency of poor glycemic control was 50.5%. Multivariate analysis (multilevel method) showed that patients with body mass indexes below 27 kg/m2, patients on oral hypoglycemic agents or insulin, and patients diagnosed as diabetic over five years prior to the interview were more likely to present poor glycemic control when compared to their counterparts.

CONCLUSIONS

Given the hierarchical data structuring, all associations found suggest that factors associated to hyperglycemia are related to patient-level characteristics.

Influence of body mass on glycemic control in a type 2 diabetic population: a 3-year follow-up

Obesity is often associated with type 2 (non insulin-dependent) diabetes. A growing body of evidence support the hypothesis that these two diseases share a common pathogenesis. Nevertheless, experience derived from clinical observation on type 2 diabetic patients indicates that reduction of body weight is not always accompanied by an improvement in metabolic control and that a good metabolic control is often obtained without influencing body composition. Aim of the present study was to evaluate the relationship between body mass and glycemic control in a type 2 diabetic population by a 3 years observational study. A cohort of 562 subjects was studied. At entry more than 80% of patients were overweight or obese according to the body mass index (BMI) scale and this proportion was not significantly reduced at the end of the follow-up. At entry all patients had a glycosylated hemoglobin (HbA1c) value above 8.1% whereas at the end of follow-up more than 2/3 of patients were in good metabolic control. No relationship was observed between modification of body mass and metabolic control. These data confirm the high frequency of obesity among type 2 diabetic individuals but they suggest that impaired glucose metabolism and alteration of body weight have different pathogenesis.

Hypertension and nephropathy

Nearly 90% of patients with hypertension and diabetes mellitus do not reach the recommended systolic blood pressure goal of <130 mm Hg. Consequently, the risk of cardiovascular and renal complications remains significant in this patient population. Study results suggest that initiating therapy with inhibitors of the renin-angiotensin system and adding diuretics may be useful in reducing arterial pressure to levels <130 mm Hg and may attenuate the progression of nephropathy. Recently, numerous studies have also found that the thiazolidinediones (TZDs) may improve insulin resistance and exert beneficial vascular effects in patients with type 2 diabetes. The TZDs have a range of vascular benefits, including mediating vasorelaxation, inhibiting angiogenesis, and improving inflammation. These findings have been associated with reduction in blood pressure and prevention of microalbuminuria. In patients with type 2 diabetes, early use of TZDs may be beneficial in both achieving glucose control and reducing the development or worsening of microalbuminuria or hypertension.

Pattern and factors associated with glycemic control of Saudi diabetic patients

BACKGROUND

The pattern and factors which can be associated with the glycemic control of Saudi adult diabetic patients were examined in this study.

PATIENTS AND METHODS

Confirmed diabetic patients from all regions of Saudi Arabia constituted the study population. Random blood glucose <10 mmol/L and >10 mmol/L was used to categorize patients into good and poor glycemic control patients, respectively.

RESULTS

There were 613 confirmed non-insulin dependent diabetic patients (NIDDM), 50% with good glycemic control. Patients with poor glycemic control were significantly older than patients with good glycemic control (51.5 vs. 47 years, P=0.0001). The insulin-treated diabetic population amounted to 13%, compared with 43% and 44% for oral agent and diet, respectively. The rate of insulin users among poor glycemic control diabetic population was 18%, compared with 50% for oral agents. There was a significant relationship between glycemic control and age, and treatment modalities of DM. Subjects who had good glycemic control of DM were younger and following a diet regimen, while those who had poor glycemic control were older and on insulin treatment. Multivariate analysis comprising 415 individuals was conducted to find out the factors that can potentially influence, or may be associated with, the control of DM.

CONCLUSION

The association of insulin therapy with poor glycemic control is not a cause-effect relationship. Insulin therapy in our study population is underutilized, given the high rate of poor glycemic control and high rate of relative occurrence of complication among the Saudi diabetic population. There is a need to address the importance of maintaining good glycemic control, and the reason for the low rate of insulin users. Close periodic monitoring of glycemic control, utilizing laboratories and home glucose monitoring devices, is required. Effective implementation of these measures, in addition to diabetes education, will have an impact on the future outcome of the Saudi diabetic population.

Prevalence of obesity in Korean non-insulin-dependent diabetic patients

A total of 15,665 Korean non-insulin-dependent diabetic (NIDDM) patients, aged over 30 years, was studied. The percent ideal body weight (%IBW) and body mass index (BMI) at the time of the study were obtained. Also, the percent maximal ideal body weight (%IBWM) and maximal body mass index (BMIM) were derived from the past maximal body weight by taking down the subject's weight histories. Other clinical characteristics such as age and sex distributions were analyzed. Laboratory findings including serum lipids and HgbA1c were determined. The results were as follows: the levels of serum total-cholesterol, LDL-cholesterol and triglyceride rose significantly as obesity increased. Also, the levels of serum total-cholesterol and LDL-cholesterol were significantly higher in the female subjects than those in the male subjects. Prevalence of obesity was 32.3% (5058 cases) at the time of study (%IBW over 120%), while 57.9% (9041 cases) were over 120% of maximal ideal body weight (%IBWM). When considering the BMI, prevalence of obesity was 32.4% (5078 cases) at the time of study (BMI over 25 kg/m2), while 60.5% (9437 cases) was over 25 kg/m2 of maximal body mass index (BMIM). The value of the BMI equivalent to the percent ideal body weight of 120% was 25.8 kg/m2 in male and 24.5 kg/m2 in female NIDDM patients in this study.