Influence of vitamin D supplementation on glycemic control in type 2 diabetics.

INTRODUCTION: Several studies have suggested a benefic impact of vitamin D supplementation on glycemic control and insulin resistance among patients with type 2 diabetes mellitus. The aims of our study were to assess vitamin D status in individuals with type 2 diabetes mellitus and to investigate the effects of vitamin D supplementation on glycemic measures in patients having vitamin D deficiency. METHODS: We conducted a comparative prospective study involved 100 Tunisian patients with type 2 diabetes followed at the National Institute of Nutrition and Food Technology of Tunis. Glycemic control and insulin resistance were evaluated in the beginning of the study and three months after supplementation. RESULTS: Baseline mean 25-Hydroxy vitamin D  (25(OH)D) level was 17.5±9.8 ng/ml. Vitamin D status was deficient in 60%, insufficient in 26% and sufficient in 14% patients. After vitamin D supplementation, mean serum 25(OH)D concentration increased significantly (p˂10-3). We observed a negative correlation between the variation of plasma 25(OH)D level and the waist circumference's variation (r=-0.266 and p=0.018). This correlation persisted after adjustment for therapeutic management. Vitamin D supplementation did significantly improve neither glycemic control nor insulin resistance parameters. CONCLUSION: Vitamin D deficiency is frequent in patients with type 2 diabetes mellitus. The metabolic effects of supplementation are controversial, hence the need of expanding studies to better demonstrate these effects.

[Diabetic papillopathy after intensification of insulin therapy: A case report]. / Papillopathie diabétique après insulinothérapie intensive : à propos d'un cas.

INTRODUCTION: Diabetic papillopathy is a rare ocular complication of diabetes. Its pathophysiology is not well known. It is a unilateral or bilateral optic disc edema with variable degrees of visual loss. OBSERVATION: A 66-year-old woman, with a twelve years old type 2 diabetes mellitus, suddenly presented a unilateral decreased vision. Her ocular examination was normal eight months earlier. Ocular examination, radiological investigations and laboratory analysis were conclusive of diabetic papillopathy. Medical history revealed a recent rapid improvement of blood glucose control after intensification of insulin therapy. A visual acuity improvement with spontaneous regression of papillary edema was observed. CONCLUSION: There is a risk of diabetic papillopathy associated with the rapid control of blood glucose levels after intensification of insulin therapy, even in diabetic patients without known retinopathy.

[Correlations between insulin sensitivity with anthropometric and metabolic parameters in type 2 diabetics]. / Étude de la corrélation entre la sensibilité à l'insuline et les paramètres anthropométriques et métaboliques dans le diabète de type 2.

AIM: The aim of the study was to evaluate correlations between insulin sensitivity and insulinosecretion with anthropometric and metabolic parameters in type 2 diabetics. MATERIALS AND METHODS: We conducted a cross-sectional study among patients with type 2 diabetes mellitus treated with oral antidiabetic medications. The evaluation of insulin resistance and insulinosecretion was based on the calculation of the HOMA-IR and HOMA-ß indices. RESULTS: The mean age for the 100diabetes recruited was 56.4±8.4years. The mean body mass index (BMI) and waist circumference (WC) were 30.5±5.7kg/m2 and 101.2±11.9cm respectively. The HOMA-IR and HOMA ß indices were respectively 3.5±2.8 and 48.9±45.5. We have found a significantly positive correlation between HOMA-IR index and weight (r=0.406, p<10-3), BMI (r=0.432, p<10-3) and WC (r=0.412, p<10-3). We noticed a significant negative correlation between HOMA ß index and fasting glucose (r=-0.457, p<10-3) and A1C (r=-0.399, p<10-3). A positive statistically significant correlation was noted between HOMA-IR and HOMA-ß (r=0.400, p<10-3). CONCLUSION: Insulin resistance is very related to overweight, especially the android distribution of fat hence the need for adequate management of this android obesity. It would also be interesting to evaluate the effects of weight loss on insulin resistance parameters.

Immunoglobulin A, G and E levels in Egyptians with cancer: influence of schistosomiasis.

The main patient series consisted of 415 Egyptians attending the Cairo Cancer Institute and comprising 286 bladder cancer, 97 breast cancer, 14 head and neck cancer and 18 gastrointestinal cancer cases. Also included in the study were 36 patients with active schistosomiasis and 89 health controls. Serum IgA, IgG, IgG subclasses, IgE, Schistosoma and Ascaris-specific IgE (RAST) and the acute-phase protein CRP were measured in all, or sub-sets, of the main patient group. The well-established increase in IgE and IgG levels, and the more recently reported increase in the levels of IgG3 and IgG4 subclasses in patients with schistosomiasis, were also found in bilharzial bladder cancer, indicating that humoral immunity persists in cancer-bearing patients. However, the plasma protein profile in bilharzial bladder cancer is further modified by significant increases in the levels of IgA, IgG, IgG1, IgG2 and CRP when compared to levels in patients with Bilharzia in the absence of neoplastic change. Patients with cancers not associated with parasitic infestation also had significant increases in their serum levels of IgG1, IgG2, IgG, IgE and CRP when compared to healthy Egyptian controls, but 41% of these non-bladder cancer patients showed IgE responses to previous parasitic infestations suggesting that any immunological response to cancer would be on the background of a variable non-specific increase of IgE.