BMP4-mediated brown fat-like changes in white adipose tissue alter glucose and energy homeostasis.

Expression of bone morphogenetic protein 4 (BMP4) in adipocytes of white adipose tissue (WAT) produces "white adipocytes" with characteristics of brown fat and leads to a reduction of adiposity and its metabolic complications. Although BMP4 is known to induce commitment of pluripotent stem cells to the adipocyte lineage by producing cells that possess the characteristics of preadipocytes, its effects on the mature white adipocyte phenotype and function were unknown. Forced expression of a BMP4 transgene in white adipocytes of mice gives rise to reduced WAT mass and white adipocyte size along with an increased number of a white adipocyte cell types with brown adipocyte characteristics comparable to those of beige or brite adipocytes. These changes correlate closely with increased energy expenditure, improved insulin sensitivity, and protection against diet-induced obesity and diabetes. Conversely, BMP4-deficient mice exhibit enlarged white adipocyte morphology and impaired insulin sensitivity. We identify peroxisome proliferator-activated receptor gamma coactivator 1-α (PGC1α) as the target of BMP signaling required for these brown fat-like changes in WAT. This effect of BMP4 on WAT appears to extend to human adipose tissue, because the level of expression of BMP4 in WAT correlates inversely with body mass index. These findings provide a genetic and metabolic basis for BMP4's role in altering insulin sensitivity by affecting WAT development.

Relationship between waist circumference and elevation of carotid intima-media thickness in newly-diagnosed diabetic patients.

OBJECTIVE: Waist circumference, as a brief indicator of visceral obesity, is associated with multi-metabolic disorders and cardiovascular diseases. The present study was aimed to find out the relationship between waist circumference and carotid intima media thickness (C-IMT), as well as the best waist circumference cutoff for identifying C-IMT elevation in Chinese male patients with newly-diagnosed diabetes. METHODS: Five hundred and seventy-eight patients from Department of Endocrinology and Metabolism in Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University were enrolled. Both physical examination (for measurement of waist circumference) and carotid ultrasonography (for measurement of C-IMT) were performed. RESULTS: After grouping according to the quartiles of C-IMT, the waist circumference increased across all its quartiles. The waist circumference in 3rd and 4th quartiles (90.7±9.8 cm and 90.8±9.6 cm) was significant higher than in 1st and 2nd quartiles (P<0.05). When subjects were divided into 4 groups according to waist circumference, the C-IMT of subjects with waist circumference 90-95 cm was significant higher than that of subjects with waist circumference 85-90 cm and less than 85 cm respectively (P<0.05). Both spearman and partial correlation analysis showed that C-IMT was positively correlated with waist circumference (P<0.01). C-IMT was found significantly elevated with the increase of waist circumference. Multiple stepwise regression analysis showed that waist circumference was one of the independent risk factors of C-IMT. After an average of 2.23±0.85 years follow up, there was a significant elevation of C-IMT in the group with baseline waist circumference over 90 cm P<0.05), while no significant difference was detected in the group with baseline waist circumference less than 90 cm (P=0.27). Logistic regression showed that baseline waist circumference over 90 cm was associated with a relative risk to C-IMT elevation of 1.132 (95% CI 1.043-1.431, P<0.05). CONCLUSION: Among newly-diagnosed diabetic male patients, waist circumference over 90 cm not only reflects sub-clinical atherosclerosis in early stage, but also predicts the progression of atherosclerosis.

[Change and significance of urinary smad3 in type 2 diabetic nephropathy].

OBJECTIVE: To explore the significance of urinary smad3(usmad3) protein level change in diabetic nephropathy (DN) in type 2 diabetes mellitus and examine its relationship with the progression of DN. METHODS: From May 2010 to August 2011, a total of 282 patients with type 2 diabetes were selected for the experimental group according to instant urine specimen albumin-creatinine ratio (UACR). Another 100 healthy subjects were taken as the control group. Then the diabetics were divided into 3 groups, including 110 with normal albuminuria (NA group), 114 with microalbuminuria (MA group) and 58 with macroalbuminuria (DN group). Enzyme-linked immunosorbent assay (ELISA) was used to detect the content of usmad3. The parameters of age, systolic blood pressure, body mass index (BMI), blood glucose, blood lipids, urinary albumin/creatinine (ACR), estimated glomerular filtration rate (eGFR) and glycosylated hemoglobin were measured. And non-mydriatic fundus camera was used to evaluate retinopathy, the DN group (n = 58) was then divided into two groups of those without retinopathy (n = 25) and with retinopathy (n = 33). RESULTS: (1) The usmad3 level in type 2 diabetes group was significantly higher than that in the control group (489(273,1193) vs 311 (179, 497) ng/mmol Cr (P < 0.01). (2) According to UACR, type 2 diabetes group was divided into 3 different groups to compare the relative level differences of usmad3 in different groups: MA group versus NA group, 552 (316,1338) vs 317 (200,594), DN group versus NA group, 1035 (503,3035)vs 317 (200,594), DN group versus MA group, 1035(503,3035)vs 552(316,1338), all P < 0.01. (3) Pearson correlation test showed the level of usmad3 was significantly correlated with age, SBP, HbA1c, blood urea nitrogen, creatinine, total cholesterol, low density lipoprotein, eGFR and UACR (r = 0.57, P < 0.01). And multiple linear regression analysis showed that usmad3 and UACR were independently correlated (ß = 0.754, P < 0.01). (4) The usmad3 level in DN with retinopathy were significantly higher than that in DN without retinopathy (1905(806,4303) vs 595 (331,1183), P < 0.01). No significant difference existed in uACR level between DN with retinopathy and DN without retinopathy(P > 0.05). CONCLUSIONS: Urinary level of smad3 is significantly elevated in type 2 diabetics and it is significantly associated with ACR. It suggests that usmad3 is a potential marker in the diagnosis of DN and may be used to predict the severity of DN.

Precise microdeletion detection of Prader-Willi Syndrome with array comparative genome hybridization.

OBJECTIVE: Prader-Willi Sydrome (PWS) is a human disorder related to genomic imprinting defect on 15q11-13. It is characterized by a series of classic features such as hypotonia, hyperphagia, obesity, osteoporosis, typical facial and body dysmorphosis, hypogonadism, mental and behaviour disorders. Our study was designed to precisely detect the microdeletions, which accounts for 65%-70% of the PWS. METHODS: Physical and laboratory examinations were firstly performed to diagnose PWS clinically, and to discover novel clinical features. Then the patient was screened with bisulfite-specific sequencing and precisely delineated through high-density array CGH. RESULTS: With the bisulfite-specific sequencing, the detected CpG island in the PWS critical region was found homozygously hypermethylated. Then with array CGH, a 2.22 Mb type II microdeletion was detected, covering a region from MKRN3, MAGEL2, NDN, PWRN2, PWRN1, C12orf2, SNURF-SNRPN, C/D snoRNAs, to distal of UBE3A. CONCLUSIONS: Array CGH, after the fast screening of Bisulfite-specific sequencing, is a feasible and precise method to detect microdeletions in PWS patients. A novel feature of metacarpophalangeal joint rigidity was also presented, which is the first time reported in PWS.

[Relation between the level of serum CA19-9 and glucose control in inpatients with diabetes].

OBJECTIVE: To investigate the effect of hemoglobin A1c (HbA1c) and glycated albumin (GA) on serum CA199 in diabetic patients. METHODS: 29 NGT matched control subjects and 371 hospitalized diabetic patients were enrolled. Diabetic patients were divided into satisfactory group (< 6.5%), general group (6.5%-7.5%) and dissatisfactory group (> 7.5%) by the level of HbA1c. The levels of serum CA199 among three groups were compared. The relationship between HbA1c and CA199, GA and CA199 was analysed. Multiple stepwise regression analysis was performed to compare the effect of different variables on CA199 as the independent variables were sex, age, duration, TC, TG, HDL, LDL, FBG, PBG, HbA1c and GA. RESULTS: (1) CA199 level of the group of HbA1c above 7.5% was significantly higher than the group of HbA1c between 6.5% and 7.5% and the group of HbA1c less than 6.5%. (2) The coefficient of correlation between HbA1c and CA199 was 0.394 (P = 0.000), and that was 0.381 between GA and CA199 (P = 0.000). (3) Multiple stepwise regression analysis show standard regression coefficient of HbA1c is 0.364 (P = 0.000). CONCLUSION: (1) CA199 level of diabetic patient in poor glucose control was significantly higher than the patient in good control. (2) CA199 was positively correlated with FBG, PBG, HbA1c and GA. (3) HbA1c is the independent risk factor of CA199. The elevated CA199 in diabetic patient has close relationship with poor glucose control in a long period.

[Association between serum uric acid level and peripheral vascular disease of lower extremities in type 2 diabetes mellitus subjects].

OBJECTIVE: To investigate the relationship between serum uric acid (UA) level and lower extremity arterial disease (LEAD) in type 2 diabetes mellitus (T2DM) subjects. METHODS: A total of 2174 T2DM individuals (1228 males, 946 females) were investigated. The case history, physical examination and biochemical tests were conducted. And LEAD was diagnosed by high-resolution ultrasound. RESULTS: In women, the serum UA levels with LEAD was significantly higher than that without LEAD [(304 +/- 76) micromol/L vs (287 +/- 71) micromol/L, P < 0.01], but not in men [(332 +/- 76) micromol/L vs (328 +/- 77) micromol/L, P = 0.45]. The subjects were divided into 4 groups (groups A, B, C, D) according to sex-specific quartiles of serum UA levels (< 240 micromol/L, 240 - 284 micromol/L, 285 - 340 micromol/L and >or= 341 micromol/L in women and< 275 micromol/L, 275 - 322 micromol/L, 323 - 377 micromol/L and >or= 378 micromol/L in men). In women, the prevalence of LEAD of 4 groups were 38.56%, 44.02%, 47.54% and 50.00% respectively (P < 0.01). And the prevalence of LEAD in groups C and D was significantly higher than that in group A (P < 0.05). But in men there was no significant difference between 4 groups. After adjusting for age, duration of diabetes mellitus, smoking status, systolic blood pressure, body mass index, total cholesterol, triglyceride and C reactive protein, the serum UA levels in women was an independent risk factor associated with the prevalence of LEAD. And the odds ratios (95%CI) of sex-specific quartiles of serum UA were 1.0, 1.25 (0.87 to 1.81), 1.44 (1.01 to 2.08) and 1.59 (1.10 to 2.30) respectively. CONCLUSION: The increase of serum UA levels is associated with LEAD in women, in addition to age, duration of diabetes mellitus, smoking status, systolic blood pressure, body mass index, total cholesterol, triglyceride and C reactive protein. Serum UA levels is an independent risk factor of LEAD in women diabetics.

Is Roux-en-Y gastric bypass advantageous?-surgical outcomes in obese patients with type-2 diabetes after gastric bypass versus sleeve gastrectomy, a matched retrospective study.

BACKGROUND: There are few comparative studies of the clinical outcomes after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The aim of the study was to compare diabetes- and metabolic disorder-related outcomes following RYGB and SG, based on data for matched participants. METHODS: This was a retrospective matched study using data from 2011-2018. Patients with type-2 diabetes undergoing RYGB (n=35) were matched with up to 2 RYGB participants (n=56) regarding age, sex, body mass index, hemoglobin A1c level, medication use, diabetes duration, and blood pressure. RESULTS: All surgeries were performed laparoscopically without complications or malnutrition during 24 months of follow-up. Both surgical procedures achieved excellent diabetes remission and weight loss. RYGB was associated with a significantly higher diabetes medication discontinuation rate 24 months postoperatively (RYGB: 87.5% vs. SG: 68.6%; P<0.05), better reduction in serum cholesterol and low-density lipoprotein-c levels, as well as better diabetes control compared with SG. The incidence of microvascular and macrovascular complications showed no significant difference between two groups. CONCLUSIONS: In this matched retrospective study, although RYGB and SG were both excellent surgeries for treating obesity in patients with type-2 diabetes, RYGB was associated with better results compared with SG regarding dyslipidemia remission and metabolic disorder-related medication reduction.

[Relationship of serum Chemerin to obesity and type 2 diabetes mellitus].

OBJECTIVE: To detect the serum Chemerin levels in patients with obesity and newly diagnosed type 2 diabetes mellitus (T2DM) and explore the relationship of serum Chemerin to body fat parameters, glucose and lipid metabolism, and insulin resistance index (IR). METHODS: 76 newly diagnosed T2DM patients and 76 subjects with normal glucose regulation (NGR), with the body mass index (BMI) < 25 kg/m(2) (NW) or > or = 25 kg/m(2) (OW/OB), 38 in each subgroups each, underwent body measurement including body weight, height, waist circumference, and hip circumference, and waist hip ratio (WHR) and calculation of body mass index (BMI) were calculated. Peripheral blood samples were collected from them to detect the blood lipids, glucose, hemoglobin A1C, fasting insulin (FINS), and fasting C peptide. Homeostasis model assessment insulin resistance index (HOMA-IR) was calculated. ELISA was used to detect the Chemerin level, body mass index (BMI) and waist hip ratio (WHR) were evaluated and insulin sensitivity was assessed by HOMA-IR. RESULTS: The serum Chemerin level of the females was (109 +/- 28) microg/L, significantly higher than that of the males [(98 +/- 23) microg/L, P < 0.05]. After adjustment of gender and age, the serum Chemerin level of the OW/OB group, including NGR-OW/OB and T2DM-OW/OB subgroups, was (113 +/- 27) microg/L, significantly higher than that of the NW group [(94 +/- 25) microg/L, P < 0.01], that of the NGR-OW/OB subgroup being the highest. Partial correlation analyses showed that the serum Chemerin was positively correlated with waist circumference, WHR, fasting serum C peptide, HOMA-IR, TG, ALT, gamma-GT, and uric acid (r = 0.460 - 0.182, all P < 0.05) and negatively correlated with high density lipoprotein-cholesterol (r = -0.251, P < 0.01). Stepwise regression analysis showed that fasting serum C peptide and TG were the independent variables of Chemerin (beta = 0.328, 0.280, P < 0.05). CONCLUSION: Serum Chemerin levels are much higher in females and obese subjects are much higher than in men and subjects with normal weight. Serum Chemerin is correlated with insulin level, body fat disposition and lipid metabolism which suggesting that it may play a role in the pathophysiology of obesity and metabolic syndrome.

[Expression of omentin in adipose tissues in obese and type 2 diabetic patients].

OBJECTIVE: To analyze the mRNA expression of omentin mRNA level in subcutaneous and omental adipose tissues of normal, obese, and type 2 diabetic individuals and to investigate the relationship between omentin mRNA expression and serum omentin level, body fat parameters, glucose and lipid metabolism, and insulin resistance indexes. METHODS: 36 patients with benign diseases undergoing selective abdominal operation, 19 males and 17 females, aged 20 - 65, included 12 with normal glucose regulation and normal weight (NGR-NW group), 12 with normal glucose regulation and overweight/obesity (NGR-OW/OB group), and 12 with type 2 diabetes and overweight/obesity (T2DM-OW/OB group). Abdominal subcutaneous and omental adipose tissues were obtained during operation. Real-time quantitative PCR was used to measure the omentin mRNA level. The level of fasting serum omentin was measured by ELISA. Meanwhile blood glucose, HbA(1C), lipids and insulin levels were measured. Body weight, BMI and waist hip ratio (WHR) were evaluated and insulin sensitivity was assessed by homeostasis model assessment insulin resistance index (HOMA-IR). RESULTS: The omentin mRNA level in omental adipose tissue of the NGR-NW group was (1.52 +/- 0.32), significantly higher than that in subcutaneous adipose tissue [(0.019 +/- 0.006), P < 0.01]. The omentin mRNA level of the males was (1.46 +/- 0.31), not statistically different from that of the female [(1.58 +/- 0.29), P = 0.416]. The omentin mRNA level of the NGR-OW/OB group was (1.18 +/- 0.29), significantly lower than that of the NGR-NW group [(1.52 +/- 0.32), P < 0.05], and the omentin mRNA level of the T2DM-OW/OB group was (0.98 +/- 0.37), both significantly lower than those of the other 2 groups (both P < 0.05). Partial correlation analysis showed that the omentin mRNA was negatively correlated with HOMA-IR, body weight, WHR, triglyceride, BMI, and fasting insulin, and positively correlated to serum omentin level and HDL-C. Multiple linear regression analysis showed that serum omentin level, HOMA-IR, and body weight were independent variables of omentin. CONCLUSION: Omentin mRNA is highly expressed in omental adipose tissue. The omentin mRNA expression level decreases in the overweight/obese individuals and decreases further when overweight/obesity is combined with type 2 diabetes. Omentin mRNA is positively correlated to serum omentin level, obese indexes, insulin resistance, and lipid metabolism parameters. Decreased omentin gene expression may contribute to the underlying pathophysiology of insulin resistance syndrome.

[Use of modification of diet in renal disease equation in estimating renal insufficiency in type 2 diabetes patients].

OBJECTIVE: To investigate the significance of use of modification of diet in renal disease (MDRD) equation in calculating glomerular filtration rate (GFR) so as to estimate the prevalence of "renal insufficiency" in type 2 diabetes patients. METHODS: Serum creatinine (Scr) and 24h-urinary albumin excretion (24 h-UAE) were measured in 1576 hospitalized type 2 diabetes patients. MDRD equation was used to calculate the GFR (GFR(MDRD)). GFR(MDRD) < 60 ml/min per 1.73 m2 was defined as "renal insufficiency". RESULTS: (1) Of the 1576 subjects, 908 (57.6%), 503 (31.9%), and 165 (10.5%) had GFR(MDRD) > or =90, 90-60, and <60 ml/min per 1.73 m2 respectively. The prevalence of "renal insufficiency" was increased with aging (P < 0.01). (2) The prevalence rates of "renal insufficiency" of the normo-, micro-, and macroalbuminuric groups were 4.8%, 14.4%, and 43.4% respectively, with significant differences among them (all P < 0.01). (3) Of the 165 subjects with "renal insufficiency", 21 (12.7%) had neither abnormal Scr nor abnormal albuminuria. CONCLUSION: Able to discover renal insufficiency early, MDRD equation has important clinical significance in evaluating the progression of renal dysfunction in type 2 diabetes patients.

[The reference values of glycemic parameters for continuous glucose monitoring and its clinical application].

OBJECTIVE: To establish reference values of glycemic parameters for continuous glucose monitoring in Chinese. METHODS: Forty-eight individuals with normal glucose regulation were observed with continuous glucose monitoring system (CGMS) for 3 days. Indexes in CGMS were analyzed, including mean level of 24 h blood glucose (BG) values (24 h MBG) and its standard deviation (SDBG), percentage of time above 7.8 mmol/L or below 3.9 mmol/L, area under the curve (AUC) of BG above 5.6 mmol/L, the largest amplitude of glycemic excursions (LAGE), mean amplitude of glycemic excursions (MAGE) and absolute means of daily differences (MODD). RESULTS: (1) The upper limits of indexes for continuous glucose monitoring were as follows: 6.5 mmol/L for 24 h MBG, 6.0 mmol/L, 6.3 mmol/L and 6.0 mmol/L for mean BG levels 1 h before breakfast, lunch and dinner respectively, 7.0 mmol/L, 6.7 mmol/L and 7.0 mmol/L for mean BG levels 3 h after breakfast, lunch and dinner respectively, 1.4 mmol/L for SDBG, 5.7 mmol/L for LAGE, 3.4 mmol/L for MAGE and 1.4 mmol/L for MODD. The percentage of time over 7.8 mmol/L was less than 9%, while the percentage of time below 3.9 mmol/L was less than 20%. The AUC of BG above 5.6 mmol/L was less than 0.9 d x mmol x L(-1). There was no statistical difference among sex subgroups (P > 0.05). (2) The correlations of 24h MBG with MAGE, MODD and SDBG were not significant (P > 0.05). MAGE was positively correlated with SDBG (r = 0.93, P < 0.01). CONCLUSION: The reference values of glycemic parameters for continuous glucose monitoring are initially established and can be used as a temporary reference for clinical practice in Chinese. The CGMS profile can reflect the overall BG control and the feature of glycemic excursions in detail.

[Change and significance of serum pigment epithelium-derived factor in type 2 diabetic nephropathy].

OBJECTIVE: To investigate the change of pigment epithelium-derived factor (PEDF) in type 2 diabetic nephropathy, and to explore the significance of PEDF in the development of diabetic nephropathy. METHODS: ELISA was used to detect the serum PEDF and immunoturbidimetry was used to measure the urinary albumin excretion (UAE) in 49 healthy controls and 132 type 2 diabetic patients, including 48 with normal urinary albumin excretion rate (NA group), 50 with microalbuminuria (MA group), and 34 with overt diabetic nephropathy (PR group). HbA1c, triglyceride (TG), total cholesterol, high density lipoprotein cholesterol (HDL-c), and highly sensitive C-reactive protein (hs-CRP) were simultaneously determined. RESULTS: The serum PEDF levels of the NA, MA, and PR groups were (3.7 +/- 2.2) mg/L, (4.7 +/- 2.9) mg/L, and (5.7 +/- 2.8) mg/L respectively, all significantly higher than that of the control group (2.7 +/- 1.3) mg/L. P < 0.05, 0.01, and 0.01 respectively). The serum PEDF levels of the MA and PR groups were significantly higher than that of the NA group (both P < 0.01), and that of the PR group was significantly higher than that of the MA group (P < 0.05). Correlation analysis demonstrated that serum PEDF level was positively correlated with HbA1c (r = 0.198, P < 0.01), FPG (r = 0.231, P < 0.01), TG (r = 0.302, P < 0.01), hs-CRP (r = 0.214, P < 0.01), and urinary albumin excretion rate (UAER) (r = 0.169, P < 0.05), significantly, but negatively correlated with HDL-c (r = -0.237, P < 0.01). Stepwise multiple linear regression analysis showed that TG (beta = 0.314, P < 0.01), hs-CRP (beta = 0.260, P < 0.01), and UAER (beta = 0.148, P < 0.05) were significant independent determinants for serum PEDF. CONCLUSION: Serum PEDF level significantly increases in type 2 diabetic patients, and the magnitude of PEDF is related to the severity of diabetic nephropathy. TG, hs-CR and UAER are significant independent determinant for serum PEDF. The increase of PEDF may involve in the development of diabetic nephropathy.

Waist circumference-dependent peripheral monocytes change after gliclazide treatment for Chinese type 2 diabetic patients.

Gliclazide used for the treatment of type 2 diabetes mellitus (T2DM) stimulates insulin secretion and influences peripheral blood monocytes. The roles of gliclazide in peripheral monocytes of newly diagnosed T2DM patients were investigated in this study. A total of 105 newly diagnosed T2DM patients with no history of antihyperglycemic medication were treated with gliclazide-modified release for 16 weeks. The total and differential leukocyte profiles of peripheral blood were measured at baseline and week 16. The peripheral blood monocyte count at week 16 was significantly lower than that at baseline (P=0.019). Peripheral monocytes level at baseline was positively correlated with waist circumference. After gliclazide treatment, the peripheral monocytes were decreased [(320.09±15.13)×106/L vs. (294.19±14.22)×106/L] in non-abdominal obesity group, but increased in abdominal obesity group [(344.36±17.24)×106/L vs. (351.87±16.93)×106/L]. Compared with non-abdominal obese patients, abdominal obese patients showed higher Δmonocytes (P=0.046) and Δacute insulin secretion (P=0.049), but lower ΔHbA1c (P=0.047). There was significantly positive correlation between Δmonocytes and Δacute insulin secretion (P=0.015), which disappeared after adjusting for age, waist circumference and dosage at baseline. In conclusion, waist circumference is correlated with peripheral monocyte change after gliclazide treatment in Chinese newly diagnosed T2DM patients. Peripheral monocytes are decreased in non-abdominal obesity group and increased in abdominal obesity group after gliclazide treatment.

[Insulin ultradian pulse model of individuals with overweight and impaired glucose tolerance].

OBJECTIVE: To study the characteristics of insulin ultradian pulses of individuals with normal glucose tolerance, overweight, and impaired glucose tolerance (IGT). METHODS: Blood samples were taken every 15 minutes from 10 individuals with normal glucose tolerance, 6 individuals with overweight and 3 individuals with IGT for 24 hours. Blood glucose, insulin, and C-peptide of every time point were measured. Standard diet was used in the study. The 24 h-ISR profile was submitted to time series analysis. RESULTS: (1) As given standard diet, 2 to 4 pulses occurred after each meal, 3 to 4 pulses occurred during the night, and 12 to 15 pulses occurred in the whole 24-hour period. The first insulin pulse always occurs 30 to 60 minutes after meal. The maximum amplitude of pulse occurred 45 to 90 minutes after meal. These characteristics were not significantly different among the 3 groups. (2) The average amplitude of 24-hour insulin secretion rate (ISR) of the normal group was 357 pmol/min +/- 11 pmol/min, significantly lower than those of the overweight and IGT groups (820 pmol/min +/- 37 pmol/min and 666 pmol/min +/- 53 pmol/min respectively, both P < 0.05). (3) The average periodicity of insulin ultradian pulse were 75 min and 75 - 90 min in the control group and overweight group respectively. The periodicity of insulin ultradian pulse in the IGT group was undefined. (4) The cross-correlation function were 0.72 +/- 0.11, 0.80 +/- 0.11 and 0.51 +/- 0.11 respectively in the normal, overweight, and IGT groups. CONCLUSION: (1) As given standard diet, the occurring numbers and time of insulin ultradian oscillations are not statistically significantly different among the normal, overweight, and IGT groups. (2) The insulin secretion amplitude is increased in the overweight and IGT groups. (3) The rhythm and concomitance coefficient of the ISR and glucose are low in the individuals with IGT.

Waist Circumference-dependent Peripheral Monocytes Change after Gliclazide Treatment for Chinese Type 2 Diabetic Patients / 华中科技大学学报（医学）（英德文版）

Gliclazide used for the treatment of type 2 diabetes mellitus (T2DM) stimulates insulin secretion and influences peripheral blood monocytes.The roles of gliclazide in peripheral monocytes of newly diagnosed T2DM patients were investigated in this study.A total of 105 newly diagnosed T2DM patients with no history of antihyperglycemic medication were treated with gliclazide-modified release for 16 weeks.The total and differential leukocyte profiles of peripheral blood were measured at baseline and week 16.The peripheral blood monocyte count at week 16 was significantly lower than that at baseline (P=0.019).Peripheral monocytes level at baseline was positively correlated with waist circumference.After gliclazide treatment,the peripheral monocytes were decreased [(320.09±15.13)×106/L vs.(294.19±14.22)×106/L] in non-abdominal obesity group,but increased in abdominal obesity group [(344.36±17.24)×106/L vs.(351.87±16.93)×106/L].Compared with non-abdominal obese patients,abdominal obese patients showed higher Amonocytes (P=0.046) and Aacute insulin secretion (P=0.049),but lower AHbAlc (P=0.047).There was significantly positive correlation between Amonocytes and Aacute insulin secretion (P=0.015),which disappeared after adjusting for age,waist circumference and dosage at baseline.In conclusion,waist circumference is correlated with peripheral monocyte change after gliclazide treatment in Chinese newly diagnosed T2DM patients.Peripheral monocytes are decreased in non-abdominal obesity group and increased in abdominal obesity group after gliclazide treatment.