RESUMO
Insulin resistance appears in several pathological conditions but unfortunately a simple, low cost, reproducible and easy to perform method to measure it isstill lacking. This method should resemble as closely as possible the physiological response to insulin and should be able to evaluate the sensitivity to the hormone of different tissues and systems. We herein analyze the factors that modify basal insulin determinations and the different methods available to measure insulin resistance.
Assuntos
Humanos , Teste de Tolerância a Glucose , Resistência à Insulina , Insulina/fisiologia , Insulina/sangueRESUMO
Background: Patients with type 2 diabetes have a high incidence of coronary artery disease, which is even higher among those with renal failure. A serum level of cystatin C are used to assess renal function and is a potential cardiovascular risk factor. Adiponectin is an anti-atherogenic factor. Aim: To measure cystatin C and adiponectin in type 2 diabetic patients with and without coronary artery disease. Material and methods: Nine diabetic patients with coronary artery disease aged 76± 10 years, 20 diabetics without coronary artery disease aged 61 ±5 years and 20 non diabetic subjects aged 57±10 years, were studied. Results: Serum levels of cystatin C (mg/L) were 1.5 (range 0.89-219), 0.81 (range 0.71-1.08) and 0.68 mg/L (range 055-0.75) in diabetics with and without coronary artery disease and controls, respectively (p <0.0001). No differences in adiponectin between groups and no association between cystatin C and adiponectin, were observed. No association between both parameters and body mass index orglycosilated hemoglobin Ale was observed. Cystatin C had a positive correlation with serum creatinine (r =0.57p <0.001). Conclusions: Diabetics with coronary artery disease have higher levels of cystatin C, that are closely correlated with serum creatinine levels.
Assuntos
Idoso , Humanos , Pessoa de Meia-Idade , Adiponectina/sangue , Doença da Artéria Coronariana/sangue , Cistatina C/sangue , /sangue , Angiopatias Diabéticas/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Doença da Artéria Coronariana/etiologia , Fatores de RiscoRESUMO
Background: The concept insulin resistance as the basis for a series of metabolic alterations and diseases was introduced by Gerald Reaven in 1988, when he described a cluster of alterations that named syndrome X. Aim: To review and discuss the present information about insulin resistance (IR) and metabolic syndrome (MS). Material and methods: The IR concept is defined,the affected metabolic ways, its consequences and relationship with different diseases are presented. The importance of central obesity with its metabolic, inflammatory and prothrombotic consequences playing a key role in cardiovascular risk, is discussed. The cluster of factors focused on cardiovascular disease and eventually diabetes is named MS. Several definitions of MS are analyzed and compared. A proposition is made about the definition to be used in the Chilean population. Differences between IR syndrome and MS are discussed. Diagnostic methods of IR and MS are presented, recommendations are made about their usefulness and reliability. Non pharmacological and pharmacological treatments of IR and MS are analyzed. Other related diseases, such as polycystic ovary syndrome, non alcoholic steatohepatitis and sleep apnea are discussed. Conclusions. Until further studies are made to define a local waist circumference cut-off associated with high risk, the ATPIII MS definition is preferred. A clinical approach is recommended for diagnosis. A search for all components of the MS is important. There is no evidence about the benefits of MS treatment on the prevention of cardiovascular diseases or diabetes. Evidence supports the use of lifestyle changes and some drugs, such as metformin on the prevention of diabetes in prediabetic states.