Using continuous glucose monitoring to assess contributions of premeal and postmeal glucose levels in diabetic patients treated with metformin alone.

AIM: This study aimed to determine the contributions of basal excess glycaemia (BEG) and prandial excess glycaemia (PEG) to overall excess glycaemia in type 2 diabetes (T2D) patients treated with metformin alone. METHODS: Outpatients with T2D treated with metformin alone (n=46) who underwent continuous glucose monitoring (CGM) were divided into tertiles according to glycated haemoglobin (HbA1c) levels. For each CGM trace, the glucose area under the curve (AUC)>5.5mmol/L was expressed as the AUCoverall, representing overall excess glycaemia. The sum of glucose AUCs above the premeal glucose level at 4h after breakfast, lunch and dinner was expressed as the AUCpeg, representing PEG. The contribution of PEG to overall excess glycaemia was calculated as (AUCpeg/AUCoverall)×100%. The contribution of BEG was calculated as [(AUCoverall-AUCpeg)/AUCoverall]×100%. Factors related to PEG contribution were also analysed. RESULTS: BEG constituted more than half the overall excess glycaemia in all HbA1c tertiles. The contribution of PEG was negatively correlated with HbA1c and mean glucose values before each meal. Prebreakfast and predinner glucose values were the dominant factors affecting PEG contribution and was independent of HbA1c. CONCLUSION: In patients treated with metformin alone, BEG was the major contributor to excess glycaemia at HbA1c levels ≥7.7%, while PEG and BEG contributions were similar and stable below this level. For HbA1c levels ≥7.7%, add-on therapy to metformin should preferentially target control of BEG, whereas targeting both BEG and PEG could be of equivalent importance with lower HbA1c levels.

The effect of soy isoflavone on bone mineral density in postmenopausal Taiwanese women with bone loss: a 2-year randomized double-blind placebo-controlled study.

UNLABELLED: The treatment of 300-mg/day isoflavones (aglycone equivalents) (172.5 mg genistein + 127.5 mg daidzein) for 2 years failed to prevent lumbar spine and total proximal femur bone mineral density (BMD) from declining as compared with the placebo group in a randomized, double-blind, two-arm designed study enrolling 431 postmenopausal women 45-65 years old. INTRODUCTION: This study evaluated the effects of soy isoflavones on bone metabolism in postmenopausal women. METHODS: Four hundred and thirty-one women, aged 45-65 years, orally consumed 300-mg/day isoflavones (aglycone equivalents) or a placebo for 2 years in a parallel group, randomized, double-blind, two-arm study. Each participant also ingested 600 mg of calcium and 125 IU of vitamin D(3) per day. The BMD of the lumbar spine and total proximal femur were measured using dual-energy X-ray absorptiometry at baseline and every half-year thereafter. Serum bone-specific alkaline phosphatase, urinary N-telopeptide of type 1 collagen/creatinine, and other safety assessments were examined regularly. RESULTS: Two hundred out of 217 subjects in the isoflavone group and 199 out of 214 cases in placebo group completed the treatment. Serum concentrations of isoflavone metabolites, genistein and daidzein, of the intervention group were remarkably elevated following intake of isoflavones (p < 0.001). However, differences in the mean percentage changes of BMD throughout the treatment period were not statistically significant (lumbar spine, p = 0.42; total femur, p = 0.39) between the isoflavone and placebo groups, according to the generalized estimating equation (GEE) method. A significant time trend of bone loss was observed at both sites as assessed by the GEE method following repeated measurement of BMD (p < 0.001). Differences in bone marker levels were not significant between the two treatment groups. CONCLUSION: Treatment with 300-mg/day isoflavones (aglycone equivalents) failed to prevent a decline in BMD in the lumbar spine or total femur compared with the placebo group.

Triglycerides are independently associated with albuminuria in Taiwanese Type 2 diabetic patients.

BACKGROUND: Lipid abnormalities in albuminuria in patients with Type 2 diabetes differ by race. AIM: To perform a biochemical investigation of association between dyslipidemia and albuminuria in Type 2 diabetes in Taiwan. MATERIALS/ SUBJECTS AND METHODS: We recruited a total of 2349 Chinese patients with Type 2 diabetes from two medical centers in Taiwan over a 1-yr period. Patients were categorized into those with normoalbuminuria, microalbuminuria, and macroalbuminuria defined as albumin-to-creatinine ratio of <30, 30- 299, and ≥300 µg/mg. We then investigated the significance of the clinical and biochemical parameters and risk of albuminuria. RESULTS: We found significant differences in total cholesterol (TC) between those with normoalbuminuria and micro/ macroalbuminuria, no significant difference in LDL cholesterol (LDL-C) among the 3 subgroups, a significant difference in HDL cholesterol (HDL-C) between those with normoalbuminuria and macroalbuminuria, and significant increases in triglyceride (TG) paralleling increases in albuminuria. TG was found by logistic regression to be significantly associated with micro/macroalbuminuria in our unadjusted model [odds ratio (OR) = 1.859 (1.596~2.165)], and remained significant after adjusting for various confounders [OR = 1.415 (1.123~1.784)]. Increases in albuminuria paralleled quartile increases in serum TG (p<0.001). CONCLUSIONS: We conclude that TG increases significantly throughout the 3 stages of albuminuria in Taiwanese Type 2 diabetic patients, but TC, HDL-C, and LDL-C do not.

Contribution of postprandial glucose to excess hyperglycaemia in Asian type 2 diabetic patients using continuous glucose monitoring.

BACKGROUND: previous studies examining the contributions of fasting glucose (FG) and postprandial glucose (PPG) to glycated haemoglobin (HbA(1c)) have yielded conflicting results. We aimed to clarify the contributions of PPG to hyperglycaemia in Asian type 2 diabetic patients using continuous glucose monitoring. METHODS: continuous glucose monitoring was conducted in 121 non-insulin-using type 2 diabetic outpatients, who were divided into five groups according to quintiles of HbA(1c) (ranging from 5.7 to 12.7%). Glucose area under the curve (AUC) above a glucose value of 5.5 mmol/L 24 or 4 h after meals was defined as AUC(total). Glucose AUC above FG or preprandial glucose levels was defined as AUC(PPG). The contribution of PPG to hyperglycaemia was calculated as (AUC(PPG)/AUC(total) × 100%. The contribution of FG or preprandial glucose was calculated as [(AUC(total) - AUC(PPG))/AUC(total)] × 100%. RESULTS: the contribution of PPG to either 24-h hyperglycaemia or 4-h hyperglycaemia after meals was significantly higher than FG and preprandial glucose in the lowest quintile of HbA(1c) (both p < 0.001). However, no difference was observed in the other four quintiles. Peak PPG and glucose excursions were higher after breakfast than those after lunch and dinner (p < 0.01 for all comparisons). CONCLUSIONS: in Asian patients with type 2 diabetes, PPG 24 and 4 h after meals was a predominant contributor to excess hyperglycaemia in well-controlled patients and was equally important as FG or preprandial glucose in moderately to poorly controlled patients with mean HbA(1c) up to 10%.

The effects of strontium ranelate in Asian women with postmenopausal osteoporosis.

The aim of this study was to assess the efficacy and safety of strontium ranelate in the treatment of postmenopausal women with osteoporosis in Taiwan. In this 12-month multicenter, randomized, double-blind, placebo-controlled study, 125 women with osteoporosis were randomly given either strontium ranelate 2 g daily or placebo. Lumbar spine, femoral neck, and total-hip bone mineral density (BMD) and biochemical markers of bone turnover were measured; adverse events and tolerability were recorded and assessed. Subjects treated with strontium ranelate showed significant increases in BMD of 5.9% at the lumbar spine, 2.6% at the femoral neck, and 2.7% at the total hip, while the placebo group exhibited no significant change at 12 months. Serum level of a formation marker (bone-specific alkaline phosphatase) was also significantly increased at 6 and 12 months. Thus, although the sample size and the treatment duration of this study could not show its effect of reducing osteoprotic fractures, strontium ranelate showed bone protection effects by increasing BMD and concentrations of a bone formation marker. Safety assessment revealed adverse events were mild and not significantly different from placebo.

Teriparatide vs. calcitonin in the treatment of Asian postmenopausal women with established osteoporosis.

This study compared the clinical efficacy, safety, and tolerability of daily subcutaneous injections of teriparatide and salmon calcitonin in the treatment of postmenopausal women with established osteoporosis in Taiwan. This 6-month, multicenter, randomized, controlled study enrolled 63 women with established osteoporosis. They were randomized to receive either teriparatide 20 microg or calcitonin 100 IU daily in an open-label fashion. Lumber spine, femoral neck, total hip bone mineral density (BMD), and biochemical markers of bone turnover were measured, and adverse events and tolerability were recorded. The results at 6 months showed that patients using teriparatide had larger mean increases in spinal BMD than those who used calcitonin (4.5% vs. 0.1%), but the BMD changes in these two groups at the femoral neck and the total hip were not significant. There were also larger mean increases in bone markers in the teriparatide group than in the calcitonin group (bone specific alkaline phosphatase 142% vs. 37%; osteocalcin 154% vs. 23%). We conclude that teriparatide has more positive effects on bone formation than salmon calcitonin, as shown by the larger increments of lumbar spine BMD and bone formation markers, and caused only mild adverse events and no significant change in liver, kidney or hematological parameters. Compared with the published global results, teriparatide seems to be equally effective and safe to use in this Asian population.

Primary hyperparathyroidism and acute pancreatitis during the third trimester of pregnancy.

The simultaneous occurrence of maternal primary hyperparathyroidism (PHPT) and acute pancreatitis during pregnancy is very rare. We report a case of concurrent PHPT and pancreatitis during the third trimester of pregnancy. A summary of the relevant literature regarding the clinical course and recommended management in relation to this case is also presented.

Intestinal obstruction in asplenia syndrome: report of three cases.

Congenital absence of spleen is rare. When it does occur, it may be associated with a characteristic group of anomalies of the cardiovascular and gastrointestinal system. Fifteen neonates of asplenia syndrome were seen in our hospital from April 1989 to November 1992, three of these fifteen cases were associated with intestinal obstruction and malrotation. All of the three neonates were noted to have cyanosis, heart murmur and abdominal distention soon after birth. Absence of spleen, heterotaxia and complex cardiac malformations were detected by sonography. Howell-Jolly bodies were found in their peripheral blood smear. The barium examinations of gastrointestinal tract showed intestinal obstruction and malrotation. All of them died in the first month of life. One of them received an autopsy.

Immunological study in three families of juvenile ankylosing spondylitis.

Three patients, all exhibiting symptoms before 15 years of age, were diagnosed as juvenile ankylosing spondylitis (JAS) by stigma of JAS. The families of these three patients--a total of fifteen first-degree relatives--had clinical, radiologic and laboratory examinations. All three patients and four family members (26%) had positive HLA-B27 and ankylosing spondylitis (AS). Five (33%) of these three family members had positive HLA-B27 but were asymptomatic; six members(40%) were HLA-B27 negative and symptom-free. A high positive rate of HLA-B27 was found among the patients (100%) and the family members (60%). The rheumatoid factor, antinuclear antibody, and anti-native DNA antibody were negative for all patients and family members. Significant elevation of IgG, IgA, and C3 were noted in the AS group. The CD3 cell was lower, and the ratio of CD4/CD8 was decreased in the AS group. Lympho-proliferative responses to phytomitogens (Con A, LPS and PHA) were also done in our study. There was no significant difference in Con A and LPS stimulation index among the AS group, symptom-free family members and normal controls.