Morbidly obese individuals with impaired fasting glucose have a specific pattern of insulin secretion and sensitivity: effect of weight loss after bariatric surgery.

BACKGROUND: Obesity is often associated with hyper-secrection of insulin. Impaired fasting glucose (IFG) has recently been redefined as a fasting plasma glucose of 5.6-6.9 mmol/L. The aim of this study was to determine whether changes in insulin secretion in morbidly obese persons also commence with normal serum glucose levels. METHODS: 32 morbidly obese subjects were studied before and after bariatric surgery. Measurements were made of glucose tolerance (K(G)), insulin sensitivity (SI), first-phase insulin release and the disposition index (DI) from a frequently sampled intravenous glucose tolerance test. RESULT: In morbidly obese subjects, the SI (P<0.01), DI (P<0.01) and first-phase insulin release (P<0.02) started changing with serum glucose levels considered to be normal (5.00-5.28 mmol/L). K(G) showed a clear slope according to the baseline glycemia status (P<0.05), and it was significantly related with the DI, both before (r=0.76, P<0.001) and after (r=0.57, P=0.002) surgery. Following surgery, all the variables significantly associated with insulin secretion and insulin sensitivity recovered significantly. The most significant changes occurred in morbidly obese individuals with IFG. CONCLUSIONS: Morbidly obese subjects show slopes of insulin sensitivity and insulin secretion in accordance with their baseline serum glucose levels. The fall in first-phase insulin release begins when serum glucose values are considered normal. Morbidly obese persons with the IFG phenotype have a specific pattern of insulin sensitivity and insulin secretion. K(G) clearly discriminates the clinical phenotypes, depending on baseline serum glucose levels.

[Postmyocardial infarction cardiac rehabilitation in low risk patients. Results with a coordinated program of cardiological and primary care]. / Rehabilitación cardíaca postinfarto de miocardio en enfermos de bajo riesgo. Resultados de un programa de coordinación entre cardiología y atención primaria.

INTRODUCTION AND OBJECTIVES: To assess the efficacy of cardiac rehabilitation with a mixed primary and cardiological care program in patients with low-risk myocardial infarction. PATIENTS AND METHOD: The participants in this 12-month prospective study were 153 consecutive patients with low-risk myocardial infarction (MI) referred to their primary care center for follow-up care. Of these patients, 113 were referred to a mixed primary and specialized care program that included physical exercise, cardiovascular risk control, an antismoking program, health education talks and psychological evaluation. The other 40 patients served as controls. We analyzed the results after 3 months and 1 year of follow-up. RESULTS: There were no differences between the two groups at baseline. After 1 year, improvements were seen in smoking habit (4.6% vs 15.6%; P<.05) and body mass index (26 [2] vs 29 [2]; P<.05). Dyslipidemia, glucose and blood pressure were similar in both groups after follow-up. Greater improvements in the group of patients who participated in the program were seen after 1 year in quality of life (78 [2] vs 91 [2]; P<.05), exercise capacity (10.3 [2] vs 8.4 [3]; P<<.01) and return to active employment (84.6% vs 53.3%; P<.05). CONCLUSIONS: After 1 year of follow-up, the cardiac rehabilitation program coordinated by cardiological and primary care services for low-risk post-MI patients improved quality of life, and increased exercise tolerance, active employment, and the number of participants who quit smoking. The mixed program also reduced body mass index. These results suggest the need for similar programs.

Rehabilitación cardíaca postinfarto de miocardio en enfermos de bajo riesgo. Resultados de un programa de coordinación entre cardiología y atención primaria / Postmyocardial infarction cardiac rehabilitation in low risk patients. Results with a coordinated program of cardiological and primary care

Introducción y objetivos. Evaluar la eficacia de un programa de rehabilitación cardíaca para pacientes con infartos de miocardio de bajo riesgo coordinados por la cardiología especializada y en colaboración con atención primaria. Pacientes y método. Un total de 153 pacientes con infarto de miocardio de bajo riesgo fueron remitidos de forma consecutiva al centro de atención primaria para proseguir con el control evolutivo. En 113 pacientes se aplicó un programa conjunto que incluía ejercicio físico, control de los factores de riesgo, programa antitabaco, charlas de educación sanitaria y valoración psicológica Los 40 pacientes restantes en los que no se aplicó el programa formaron el grupo control. Resultados. No se observaron diferencias basales entre los 2 grupos. A los 3 y a los 12 meses mejoró el abandono de tabaco (4,6 frente al 15,6 por ciento a los 12 meses; p < 0,05) y el índice de masa corporal (26 ñ 2 frente a 29 ñ 2 a los 12 meses; p < 0,05). La dislipemia, la glucemia y la presión arterial estuvieron controladas por igual. El grupo activo mejoró la calidad de vida al año de seguimiento (78 ñ 2 frente a 91 ñ 2, p < 0,05), la capacidad de esfuerzo medida en equivalentes metabólicos (10,3 ñ 2 frente a 8,4 ñ 3; p < 0,01) y el retorno laboral (el 84,6 frente al 53,3 por ciento; p < 0,05).Conclusiones. En enfermos con antecedentes de infarto de miocardio de bajo riesgo que realizan un programa de rehabilitación cardíaca coordinado entre cardiología y atención primaria se observa una mejoría de la calidad de vida y de la tolerancia al esfuerzo, un mayor retorno laboral, un mayor abandono del hábito tabáquico y una disminución del índice de masa corporal al año de seguimiento. Estos resultados indican la necesidad de potenciar programas similares (AU)