Visceral adipose tissue as an indicator of insulin resistance in nonobese patients with new onset type 2 diabetes mellitus.

BACKGROUND: Obesity and type 2 diabetes mellitus are characterized by insulin resistance. We determined the relationship between insulin resistance and visceral adipose tissue (VAT) and their correlation with bioimpedance analysis in nonobese new onset type 2 diabetes patients. METHODS: A number of 30 new onset type 2 diabetes patients and 20 healthy control subjects with similar features, age between 45 - 72 years old, BMI < 27 kg/m (2), C-peptide > 0.6 nmol/L, were included in study. Fasting blood glucose, HbA1c, serum lipids, BMI, insulin, C-peptide, HOMA-IR, bioimpedance analysis and visceral and subcutaneous adipose tissue (by computed tomography) were measured. RESULTS: In the patient group, VAT was significantly higher compared to healthy control group (33.17 +/- 10.23 % vs. 16.53 +/- 7.85 %, p < 0.001). In the patient group VAT was correlated with HOMA-IR (r = 0.62, p = 0.003), but no significant correlation was observed between VAT and bioimpedance analysis. CONCLUSIONS: The amount of VAT is significantly higher in nonobese new onset patients with type 2 diabetes than the healthy control group. In these patients, VAT measured by CT is an important indicator of insulin resistance. Although bioimpedance analysis can give an idea about total body fat and obesity, it is not sufficient in evaluating fat distribution and therefore is not effective in predicting insulin resistance.

Extramedullary plasmacytoma of the maxillary sinus.

Extramedullary plasmacytomas (EMPs) are localized plasma cell neoplasms that occur within the soft tissues; by definition they cannot occur within bone. They account for 1-2% of all plasma cell growths and have a great predilection for the upper respiratory tract, without specific manifestations. Males are more frequently affected during the fifth and sixth decades of life. At initial presentation, multiple myeloma should be excluded. We report herein the case of a 63-year-old man with an EMP arising in the right maxillary sinus who was referred for surgical excision and postoperative radiotherapy and briefly review the clinical implications and management of this pathology.

Comparison of various insulin sensitivity indices in psoriatic patients and their relationship with type of psoriasis.

AIM: We aimed to identify insulin resistance and its possible association with types, duration and severity of psoriasis, and to evaluate various simple insulin-sensitivity indices and beta-cell function in psoriasis. METHODS: A cross-sectional study was performed in 110 non-obese adults (18-50 years old): 70 with psoriasis (53 type I, 17 type II psoriasis) and 40 healthy individuals. Blood glucose, insulin and C-peptide levels were measured. Oral glucose tolerance test (OGTT); insulin sensitivity and beta-cell function indices derived from a single sample and OGTT were determined and compared in three groups. RESULTS: Total, type I and type II psoriatics had IGT rates of 18.6%, 13.2% and 40%, respectively. In the control group IGT was only 2.5%. Homeostasis Model Assessment (HOMA) beta cell index, fasting insulin, Raynaud index, HOMA-IR and FIRI results were higher in total, type I and type II psoriatics than in controls (P < 0.05, for all). Fasting Belfiore index, QUICKY index, ISI HOMA and FIRI(-1) results were lower in total, type I and type II psoriatics than in controls (P < 0.05, for all), and type I psoriatics had higher levels of these indices than type II psoriatics (P < 0.05, for all). CONCLUSION: Our study showed that psoriatic patients were more insulin resistant than healthy subjects and type II psoriatics were more susceptible than type I psoriatics to develop IGT. We suggest that beta-cell function and insulin sensitivity indices are useful methods for measuring insulin resistance in psoriatics. We propose that OGTT should be applied especially in type II psoriatics because of increased rate of IGT in this group.

Comparison of additional metformin or NPH insulin to mealtime insulin lispro therapy with mealtime human insulin therapy in secondary OAD failure.

AIM: It has been found that non-fasting plasma glucose is a better marker of diabetic control than fasting plasma glucose in type 2 diabetes. The main aim of treatment of type 2 diabetic patients is to control plasma glucose and HbA1c levels. In this study, we aimed to assess the effects of three different insulin regimens (group I: lispro insulin + NPH insulin, group II: lispro insulin + metformin and group III: regular insulin + NPH insulin) on overall glycaemic control and metabolic parameters in type 2 diabetic patients with secondary oral anti-diabetic drug failure. METHODS: Sixty type 2 diabetic patients with secondary OAD failure were randomly allocated into three different treatment groups equally. There were no significant differences between groups concerning age, body mass index, diabetes duration, HbA1c and serum lipid levels at the beginning of the study. During the 6-month treatment period, blood glucose levels were determined 10 times during 24 h at pre-meal, post-prandial 1 and 2 h and at bedtime. RESULTS: Group I was found to be the most effective treatment regimen in controlling HbA1c levels (group I vs. group II, p = 0.013; group I vs. group III, p = 0.001; group II vs. group III, p > 0.05). When the comparison was made in each group, change in HbA1c was statistically significant for all groups (-3.18%, p = 0.001; -2.02%, p = 0.043 and -2.66%, p = 0.008 respectively). Group I was found to be more effective in controlling fasting and post-prandial plasma glucose levels measured at all times during the day when compared with group II and group III. In group II triglyceride levels were found to be significantly reduced, whereas other groups had no effect on lipids. No serious hypoglycaemic episodes were observed in any of the cases, whereas in group I hypoglycaemic episode rates were increased (chi2 = 8.843, p = 0.012). CONCLUSIONS: Lispro insulin plus NPH insulin regimen is more effective in controlling both pre- and post-prandial glucose levels and HbA1c when compared to regular insulin plus NPH insulin combination. Mealtime lispro insulin plus metformin combination therapy should also be seriously considered as an effective and alternative treatment regimen. It is worthy of attention that insulin lispro plus metformin lowered triglyceride levels.