Metabolic risk factors in southern Taiwanese with impaired fasting glucose of 100 to 109 mg/dL.

This study investigates the influence of changes in impaired fasting glucose (IFG) criteria by the American Diabetes Association in 2003 in estimating the prevalence and cardiovascular risks in Taiwanese with fasting plasma glucose (FPG) between 100 and 109 mg/dL. Data came from a cross-sectional study on 1411 participants aged 30 years and older without known diabetes in southern Taiwan. Besides collection of anthropometric and biochemistry data, a 75-g oral glucose tolerance test was performed. The new IFG criteria additionally identified 14.2% of all participants as having IFG100, with FPG between 100 and 109 mg/dL, among which the percentage of normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus were 7.7%, 5.0%, and 1.5%, respectively. Mean body weight, body mass index, abdominal girth, systolic blood pressure, diastolic blood pressure (DBP), 2-hour glucose, and triglyceride were significantly higher in the IFG100 group than in normal fasting glucose (NFG) group (FPG, <100 mg/dL). Moreover, body weight, body mass index, systolic blood pressure, DBP, and 2-hour glucose were statistically higher in subgroups of IFG100/IGT than in NFG/NGT. In contrast, only DBP and 2-hour glucose were significantly higher in the IFG100/NGT group than in the NFG/NGT group. The 2003 criteria increased the prevalence of IFG and identified more IGT and diabetes. However, the increase of cardiovascular risks among newly identified IFG100 subjects came from those who concomitantly had IGT.

Cholesteryl ester transfer protein B1B1 genotype as a predictor of coronary artery disease in Taiwanese with type 2 diabetes mellitus.

Diabetes is known to be a high-risk factor for coronary artery disease (CAD), and lipid abnormalities have been found to possibly contribute to CAD in diabetic patients. Cholesteryl ester transfer protein (CETP) gene TaqIB polymorphism is associated with lipid profile variability, and this polymorphism may be a risk factor for CAD in diabetic patients. To clarify the relationship between CETP TaqIB gene polymorphism and CAD, we enrolled in our study 365 Taiwanese with type 2 diabetes mellitus (101 with CAD and 264 without CAD). The genotype of the subjects for TaqIB polymorphism of CETP in intron 1 was analyzed by using polymerase chain reaction-restriction fragment length polymorphism. The CETP B1B1 genotype (18.8% vs 8.5%, P = .002) and B1 allele (42.1% vs 29.7%, P = .002) were significantly more frequent in diabetic patients with CAD than those without CAD. Logistic regression analysis revealed that the CETP B1B1 genotype was associated with CAD in patients with type 2 diabetes mellitus (odds ratio, 3.18; 95% confidence interval, 1.54-6.54; P = .002). Interestingly, in diabetic patients, serum creatinine levels higher than 1.4 mg/dL were also associated with increased risk for CAD (odds ratio, 2.09; 95% confidence interval, 1.12-3.91; P = .02). Our results suggest that the CETP B1B1 genotype is a strong genetic predictor of CAD in Taiwanese with type 2 diabetes mellitus.

Acute suppurative thyroiditis with deep neck infection: a case report.

Thyroid gland suppuration is a rare condition with nonspecific features. For this reason, diagnosis is often delayed, which may lead to a life-threatening situation. Causative agents are often gram-positive bacteria, such as Staphylococcus aureus and Streptococcus pneumoniae. With appropriate antibiotics and drainage of the abscess, the prognosis is usually excellent. Herein, we describe a unique case of acute suppurative thyroiditis in an adult male presenting with nonspecific sore throat after a fish bone injury to the throat. The patient had a history of essential hypertension and gouty arthritis. In the emergency room, fever, chills, and neck swelling were noted. Thyroid echo and computed tomography of the neck revealed the thyroid abscess with deep neck infection. The culture of the abscess showed Streptococcus viridans. He recovered gradually after parenteral antibiotics and surgical intervention.

Insulinoma-associated transient hypothalamus-pituitary-adrenal axis impairment and amelioration by steroid therapy and surgical intervention: a case report.

Insulinoma is the most common functional tumor among pancreatic islet cell tumors. This type of tumor is difficult to localize prior to surgery and can lead to serious hypoglycemia. This paper presents the case of a young female who suffered from insulinoma associated with transient hypothalamus-pituitary-adrenal axis impairment. To localize her insulinoma, we used two alternative testing methods, somatostatin receptor scintigraphy and selective arterial calcium stimulation with venous sampling, after a failure of conventional imaging methods. We treated her adrenal insufficiency and prevented serious hypoglycemia by giving her prednisolone. The impairment in her hypothalamus-pituitary-adrenal axis and her serious hypoglycemia recovered after excision of the tumor.

Subacute thyroiditis following influenza vaccine (Vaxigrip) in a young female.

Subacute thyroiditis (SAT), also called de Quervain thyroiditis or granulomatous thyroiditis, is a self-limiting, possibly viral, and inflammatory thyroid disorder that is usually associated with thyroid pain and systemic symptoms. This report details a case of SAT possibly associated with influenza vaccine (Vaxigrip) in a young female. The diagnosis, therapeutic management and outcome are discussed.

Acute brachial artery thrombosis: a rare complication of diabetic ketoacidosis.

Diabetes mellitus is a worldwide disease that leads to several acute complications including diabetic ketoacidosis, hyperosmolar hyperglycemia, and hypoglycemia. In addition, diabetes causes many chronic complications that lead to debilitation and diminished quality of life. Diabetic ketoacidosis is one of the serious acute complications; however, it is usually preceded by infection, acute myocardial infarction, stroke, or other dire events. Rarely does it accompany acute arterial thrombosis. Here, we report on a female patient who suffered from diabetic ketoacidosis combined with acute brachial artery thrombosis. After emergency treatment, including insulin therapy and surgical thrombectomy, the brachial artery was rescued and her prognosis was good.

Emphysematous cystitis, a rare complication of urinary tract infection in a male diabetic patient: a case report.

Emphysematous cystitis is a rare complication of urinary tract infection, characterized by spontaneous gas formation in the urinary bladder due to bacterial fermentation. Approximately 50 to 80% of patients with this disease are diabetic, and there is a higher incidence in females. We report a case of emphysematous cystitis in a diabetic male who was admitted under the impressions of hypoglycemia, acute bronchitis, and chronic renal failure. Treatment of the emphysematous cystitis consisted of adequate urinary drainage, empirical antibiotic therapy, and strict blood sugar control. The patient recovered satisfactorily after 9 days of hospitalization.

Carney complex, a familial Cushing's syndrome due to primary pigmented nodular adrenocortical disease: a case report.

A 45-year-old woman with adrenocorticotropin (ACTH)-independent hypercortisolism, diabetes mellitus, and hypertension had undergone left adrenalectomy for ACTH-independent Cushing's syndrome 20 years prior to this presentation. There was cushingoid appearance 1 year after surgery. However, Cushing's syndrome recurred; ACTH-independent Cushing's syndrome was diagnosed and abdominal computerized tomography showed a right adrenal tumor, which was removed. Histology revealed primary pigmented nodular adrenocortical disease (PPNAD). The patient had also undergone hysterectomy for uterine masses diagnosed as uterine myxoma. Right breast and neck skin masses were also found, both of which were removed and diagnosed as mammary myxoid fibroadenoma and cutaneous myxoma. She had a homozygotic twin sister who also had Cushing's syndrome and had undergone bilateral adrenalectomy 13 years previously with a pathologic diagnosis of PPNAD. The twin sister also had skin, breast, and uterine masses, all of which were resected. The pathologic results were the same as this patient's. According to the clinical presentations, histologic findings, and positive family history, familial PPNAD (Carney complex) was diagnosed.

Diabetic muscle infarction in association with terlipressin therapy: a case report.

Diabetic muscle infarction (DMI) is a rare complication that often exists in long-standing diabetic patients. Clinically, it presents with pain, swelling and sometimes a palpable mass, and is often misdiagnosed as soft tissue infection. The athogenesis of DMI is uncertain. We present the case of a type 2 diabetic patient with liver cirrhosis who was diagnosed with muscle infarction after being treated with terlipressin for gastrointestinal bleeding. This 45-year-old male complained of increasing pain in his right posterior thigh after treatment with terlipressin for 2 days. He was initially diagnosed with soft tissue infection, but he responded poorly to antibiotic treatment. Magnetic resonance imaging suggested acute muscle infarction. We performed a muscle biopsy and the pathologist reported that the muscle was necrotic. After 5 days of bed rest, the patient was able to walk and was discharged uneventfully.

Effectiveness of comprehensive diabetes care program in Taiwanese with type 2 diabetes.

OBJECTIVE: To assess continuing diabetic education in Taiwan, we evaluated the impact of comprehensive diabetes care program for Taiwanese people with type 2 diabetes. METHODS: 211 diabetic patients were enrolled and followed up for 1 year at Kaohsiung Medical University Hospital. Patients were provided comprehensive care and their medications were not changed. Clinical and biophysical variables were collected and assessed at 0, 3, 6, 9, 12 months. RESULTS: Metabolic control had improved significantly by 1 year: fasting plasma glucose (164.6+/-60.4 vs. 137+/-37.5mg/dl, p<0.001); total serum cholesterol (198.7+/-38.8 vs. 187.2+/-43.1mg/dl, p<0.001); high-density lipoproteins cholesterol (43.2+/-10.2 vs. 46.2+/-11.7 mg/dl, p<0.001); low-density lipoproteins cholesterol (121.1+/-32.9 vs. 113.1+/-29.6 mg/dl, p<0.005). In the male group, HbA1c level fell from 8.16+/-1.99% to 7.61+/-1.31% and 7.72+/-1.40% after 9 months and 1 year, respectively, p<0.05. There were also significant improvements in female group after 6 months and 9 months (7.89+/-1.62% after 6 months; 7.94+/-1.66% after 9 months vs. 8.22+/-1.70% at baseline). The change of HbA1c level was significant in male patients, patients whose duration of disease was shorter and in those with higher baseline HbA1c levels after multi-variable and age-adjusted analysis. CONCLUSION: The comprehensive diabetes care program effectively improved glycemic and cholesterol control. The patients who were more likely to achieve better glycemic control were male, had diabetes for shorter periods of time and had high baseline HbA1c levels. Therefore, diabetic education should be offered to patients as close to the time of diagnosis as possible.

Decreased insulin secretion and insulin sensitivity are associated with liver function in subjects with fasting glucose between 100 and 109 mg/dL in Taiwanese population.

OBJECTIVE: In 2003, the American Diabetes Association recommended that the lower limit for the diagnosis of impaired fasting glucose (IFG) should be reduced from 110 to 100 mg/dL in the analysis of the associated risk factors of IFG. It has been proposed that liver dysfunction may contribute to the development of type 2 diabetes. A primary aim was to investigate the relationship between liver enzyme and insulin resistance (IR) in IFG group. The secondary aim was to investigate IR and beta-cell function assessed by homeostasis model assessment (HOMA-IR and HOMA-%B, respectively) in subjects with fasting plasma glucose (FPG) between 100 and 109 mg/dL. METHODS: We enrolled 284 subjects whose medical history and physical examination required tests to screen for metabolic abnormalities. In addition, we also excluded all factors affecting glucose or insulin metabolism. According to the FPG level, they were divided into the following groups: group A, FPG < 100 mg/dL; group B, FPG = 100 to 109 mg/dL; group C, FPG = 110 to 125 mg/dL. RESULTS: Group B as compared with group A had significant increase of HOMA-IR and decrease of HOMA-%B. Among the whole population, the fasting insulin level, the fasting glucose, HbA1c, HOMA-IR, alanine aminotransferase, gamma-glutamyltranspeptidase, aspartate aminotransferase, and the diastolic blood pressure all increased significantly as the glycemic status progressed, whereas HOMA-%B levels decreased significantly as the glycemic status progressed. The lipid profile, alkaline phosphatase, and systolic blood pressure did not differ significantly among 3 different glycemic classifications. CONCLUSIONS: Study results indicate that, first, there was a significant decrease of insulin sensitivity and insulin secretion in subjects with fasting glucose from 100 to 109 mg/dL compared with subjects with normal fasting glucose. Second, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltranspeptidase were associated with IR as the glycemic status progressed in the IFG group.

The hOGG1 Ser326Cys gene polymorphism is associated with decreased insulin sensitivity in subjects with normal glucose tolerance.

Increased oxidative stress has been observed to contribute the development of insulin resistance. Oxidative stress is known to increase the conversion of deoxyguanosine (dG) to 8-hydroxy-2'-deoxyguanosine (8-OHdG). Human 8-oxoguanine glycosylase (hOGG1) is the key component responsible for the removal of 8-OHdG from oxidatively damaged DNA. The repair activity of the hOGG1 Ser326Cys gene variant has been demonstrated to be lower than that of the hOGG1 Ser/Ser genotype. Therefore, the possible association of the hOGG1 Ser326Cys gene variant with insulin sensitivity was investigated in 279 normal glucose-tolerant subjects without history of cancer. Allele frequency was 21.5% for the Ser/Ser genotype (n = 60), 45.9% for the Ser/Cys genotype (n = 128), and 32.6% for the Cys/Cys genotype (n = 91). Subjects carrying the Cys/Cys genotype had significantly lower insulin sensitivity levels, assessed by homeostasis model assessment-insulin resistance (HOMA-IR), compared with the Ser/Ser and Ser/Cys genotypes (P < 0.001 and P < 0.001, respectively). In a multiple linear regression analysis, the Cys/Cys genotype was a significant determinant of HOMA-IR, independent of age, sex, body mass index, fasting plasma cholesterol, triglyceride, HDL cholesterol, LDL cholesterol, or hypertension. The present study indicates that the hOGG1 gene Cys/Cys variant is associated with a significant decrease in insulin sensitivity in subjects with normal glucose tolerance.