[Cardiovascular risk factors and treatment with insulin in type II diabetic patients in whom oral hypoglycemic drugs have failed]. / Factores de riesgo cardiovascular y tratamiento con insulina en pacientes diabéticos tipo II en quienes ha fracasado el tratamiento con hipoglucemiantes orales.

BACKGROUND: To find whether insulin treatment in type II diabetic patients in whom treatment with oral hypoglycemic treatment has failed changes body fat distribution or modifies cardiovascular risk factors. METHODS: Twenty-six patients (16 women and 10 men with a mean age of 62.3 +/- 9.8 years and 12.8 +/- 8.5 years of evolution) were studied before and 3 months after starting insulin treatment at a daily dose of 0.3 IU/kg of body weight. RESULTS: HbA1c decreased from 9.9 +/- 2.1 to 8.2 +/- 1.6% (p < 0.001) similar to fructosamine (from 407 +/- 86 to 350 +/- 71 mumol/l; p < 0.001) following treatment with insulin, but a increase in body weight, body mass index, blood pressure and a decrease in the concentration of HDL-cholesterol (p < 0.05) were observed. Weight was gained in 21 patients (80%) (3.7 +/- 1.9 kg), increasing body fat of central distribution in 13 (50%) and of peripheral distribution in 8 (30%). The patients in whom body fat of central distribution was increased fundamentally differentiated from the remaining patients by having a greater body mass index (p < 0.01), in all cases greater than 25 kg/m2 upon initiation of the insulin treatment, and by a significantly greater increase in body weight, blood pressure and total cholesterol after the insulin treatment. Patients who increased body fat of peripheral distribution or who did not gain weight did not present these changes in cardiovascular risk factors and were characterized by an increase of at least 500 kcal/week consumed by physical exercise. CONCLUSIONS: Treatment with insulin in type 2 diabetic patients in whom oral hypoglycemic drugs have failed improves glycemic control, but induces an increase in weight and worsens cardiovascular risk factors in patients with a CMI greater than 25 kg/m2. This change may be prevented by an increase in physical activity.

[Influence of pancreatic insulin reserve on the metabolic control of type I and II diabetes mellitus]. / Influencia de la reserva pancreática de insulina sobre el control metabólico de las diabetes tipos I y II.

We have studied 22 diabetic patients, 14 type I and 8 type II, in order to determine if there is a correlation between metabolic control and pancreatic reserve of insulin. All the patients were treated with optimum doses of bolus/basal insulin. They underwent a peptide C test (at baseline and after 3 stimulus with glucagon) and every month, during 3 months, HbA1c and fructosamine were measured, with monthly self control of glycemia. Both HbA1c and fructosamine showed a statistically significant improvement during the study. In all the cases, there was a negative correlation between metabolic control and pancreatic reserve, with statistical significance for type I, especially regarding the response of peptide C to the administration of glucagon. We conclude that the preservation of a good endogenous secretion of insulin benefits the metabolic control of diabetes.