Association between improvements in insulin resistance and changes in cognitive function in elderly diabetic patients with normal cognitive function.

AIM: The number of elderly with cognitive dysfunction has been increasing in developed countries. Several studies have shown that diabetes is a risk factor for declines in cognitive function and, recently, numerous studies have demonstrated that exercise improves insulin resistance (IR). However, no studies have been undertaken to examine the relationship between IR and cognitive dysfunction. METHODS: Sixteen elderly diabetic patients participated in this study (mean age 70.9 ± 3.7 years). They were divided into control and training groups, and the training group was instructed to exercise 4 days per week for 12 weeks using horse riding simulation equipment (JOBA). Insulin sensitivity was measured by the euglycemic clamp technique and several tests to assess cognitive function, such as the Mini-Mental State Examination (MMSE), were performed. RESULTS: There were no statistically significant differences between the control and training groups in the baseline data. The differences of glucose infusion rate values and delayed word list scores, between baseline and the follow up, were significantly correlated (P = 0.024). In addition, changes in fasting blood sugar (FBS) and in the Trail Making Test B (TMT-B) score were also correlated (P = 0.035). CONCLUSION: The current study showed that a 12-week exercise intervention program did not significantly improve IR in elderly diabetic patients. However, changes in IR were associated with improvements in memory function, and reduced FBS was associated with improvements in TMT-B.

Glucose intolerance in Japanese patients with obstructive sleep apnea.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) often accompanies obesity and diabetes mellitus. This study was performed to investigate the prevalence of glucose intolerance and to determine independent predictors for insulin resistance in patients with OSAS. METHODS: A cross-sectional study of 679 OSAS patients with an apnea-hypopnea index (AHI)>or=5/h and 73 controls subjects (AHI<5/h) was done in a tertiary university-based medical center. They were assessed by nocturnal polysomnography and underwent an oral glucose tolerance test. RESULTS: The prevalence of diabetes mellitus in OSAS patients was higher than that of the control group (25.9% vs. 8.2%, p<0.001) and 424 patients (62.4%) received a new diagnosis of impaired glucose tolerance or diabetes mellitus. The very severe OSAS group (AHI >or=45/h) had significantly higher homeostasis model assessment of insulin resistance (HOMA-IR) and HOMA beta-cell function than the other OSAS groups (AHI<45/h) and the control group. In a logistic regression model adjusting for potential confounders: age, AHI, minimum SpO(2) and body mass index (BMI), only BMI was associated with insulin resistance (HOMA-IR>3) (odds ratio: 1.272, 95% confidence interval 1.206-1.343, p<0.0001). CONCLUSION: Glucose intolerance was more common in patients with OSAS. Insulin resistance was associated not with AHI but rather with BMI.

Associations of periodontal damage and tooth loss with atherogenic factors among patients with type 2 diabetes mellitus.

OBJECTIVE: To clarify the associations of periodontal damage and tooth loss with atherogenic factors among diabetic patients. METHODS: We examined the correlations of age, sex, smoking, oral hygiene score, blood pressure, body mass index, and blood chemical data with the mean depth of periodontal pockets or the number of remaining teeth. PATIENTS: One hundred outpatients with type 2 diabetes aged 29 to 77 years. RESULTS: The mean depth of periodontal pockets was significantly associated with smoking, oral hygiene score, and HbA1c; the Spearman correlation coefficients (r) were 0.220, 0.417, and 0.260, respectively. Age, oral hygiene score, and HbA1c were inversely correlated with the number of remaining teeth (r=-0.306, -0.287, and -0.275, respectively). Serum total cholesterol was significantly correlated with the mean depth of pockets after adjustment for smoking, oral hygiene score, and HbA1c (r=0.211; P=0.044), while serum HDL cholesterol tended to be negatively associated with depth (r=-0.202; P=0.055). Serum HDL cholesterol was also associated with an increased number of teeth, which remained significant after adjustment for age, oral hygiene score, and HbA1c (r=0.202; P=0.048). The estimated glomerular filtration rate was significantly and positively correlated with the number of teeth in the univariate analysis, although consideration of the potential confounding factors somewhat weakened the association (r=0.186; P=0.069). CONCLUSIONS: We may expect better management of oral health in diabetic patients with control of dyslipidemia in addition to blood glucose.

Subjective health values of individuals with diabetes in Japan: comparison of utility values with the SF-36 scores.

To investigate the characteristics of utility values for current health states and the Medical Outcome Study Short Form 36 (SF-36) scores in terms of patients' preferences, we performed the utility assessment using the visual analog scale (VAS) and the standard gamble (SG) techniques, and the SF-36 questionnaires on 68 hospitalized individuals with diabetes. Sixty patients responded appropriately. The SG value, 0.93 +/- 0.12 (mean +/- S.D.), was significantly higher than the VAS value, 0.65 +/- 0.21 (P<0.001). A tendency for the SF-36 subscale scores to decrease compared to national normative data for Japan was observed. Diabetic conditions such as glycated hemoglobin level and daily insulin injection were not significant predictors of either utility or SF-36 scores, while diabetic complications affected two subscales of the SF-36. The VAS values were somewhat related to the SF-36 subscale scores but the SG values had no relation to any SF-36 scores. These results suggest the difficulty of estimating the subjective health values of the patients only through the traditional clinical indicators and the SF-36 scores.

Prevalence of diabetes mellitus in Japanese patients infected chronically with hepatitis C virus.

BACKGROUND: To examine the relationship between hepatitis C virus (HCV) infection and diabetes mellitus (DM) in Japanese populations, a retrospective study was done in 866 patients with chronic viral disease. METHODS: The present study included 707 HCV-infected and 159 hepatitis B virus (HBV)-infected patients. The prevalences of HBV- and HCV-related cirrhosis were 32% and 33%, respectively. A case-control study was also conducted to determine the seroprevalence of HCV infection in a cohort of 459 diabetics. RESULTS: The prevalence of DM was higher in HCV-infected patients (20.9%; P < 0.02) than in HBV-infected subjects (11.9%). In the cirrhotic patients, DM was observed in 30.8% of the subjects with HCV compared with 11.8% of those with HBV ( P < 0.01). Multivariate analysis revealed that the major independent variables associated with type II DM were male sex (odds ratio, 1.54; p = 0.020) and cirrhosis (odds ratio, 1.97; P = 0.0007). The relative odds of the development of DM were calculated to be 3.2 times higher in HCV-infected cirrhotic patients than in HBV-infected ones. In the case-control study of the diabetic cohort, 10.5% of patients were infected with HCV compared with 1.1% with HBV ( P < 0.0001). The results indicate that HCV infection is closely associated with DM, compared with HBV infection. Cirrhosis was an independent risk factor for DM. CONCLUSIONS: Taken together, the findings indicate that cirrhosis appears to be a more important predictor of glucose intolerance than HCV infection, and the combination of both factors increases the risk of DM in our populations.

The effect of walking before and after breakfast on blood glucose levels in patients with type 1 diabetes treated with intensive insulin therapy.

OBJECTIVE: We examined the effect of walking at different timing on carbohydrate metabolism in patients with type 1 diabetes. SUBJECTS AND METHODS: Subjects included six non-obese patients treated with intensive insulin therapy. The blood glucose profile was determined with and without walking for 30 min before (ExBM) or after (ExAM) breakfast. RESULTS: Mean blood glucose values at 07:00 h in the control, ExBM, and ExAM were 9.0, 8.0, 8.8 mM, respectively. Glucose levels gradually increased after meals up to 13.6, 15.0, and 15.3 mM, respectively, at 09:00 h (0.5 h after meals). At 09:30 h, glucose levels significantly fell to 11.0 mM during walking in the ExAM (P=0.039 vs 09:00 h values). The area under blood glucose response curve was significantly lower only in the ExAM when compared with that in the control (P=0.043) (11.8, 17.8. and 3.8 h mM in the control, ExBM and ExAM, respectively). CONCLUSION: These results might suggest that walking after meals improves glycemic control in patients with type 1 diabetes being treated with intensive insulin therapy consisting of the basal-bolus (NPH-human regular) insulin regimen.