Relationship between Serum Concentration of Uric Acid and Insulin Secretion among Adults with Type 2 Diabetes Mellitus.

To determine the relationship between serum concentrations of uric acid and insulin secretion with hyperglycaemic clamp technique among adults with type 2 diabetes mellitus (DM2) without hyperuricemia, we carried out a cross-sectional study on 45 patients of both gender. We observed correlation between uric acid with male gender r = 0.710 (P = 0.001). Also correlation between uric acid and total insulin secretion was positive r = 0.295 (P = 0.049). As well as a positive correlation adjusted for body mass index was demonstrated for the first, second, and total phases of insulin secretion, respectively, r = 0.438 (P = 0.022), r = 0.433 (P = 0.022), and r = 0.439 (P = 0.024). Serum concentration of uric acid showed a positive relationship with the total phase of insulin secretion; even in states prior to hyperuricemia, uric acid can play an important role in the function of the beta cell in patients with DM2.

Prevalence of metabolic syndrome in adults with excess of adiposity: comparison of the Adult Treatment Panel III criteria with the International Diabetes Federation definition.

The aim was to compare the Adult Treatment Panel (ATP) III criteria with the International Diabetes Federation (IDF) definition of metabolic syndrome (MS) in adults with excess adiposity who were considered a high-risk population. A cross-sectional study was carried out in 274 adults with excess adiposity. MS was assessed in all volunteers considering the ATP III criteria and the new IDF definition. Among all individuals, 130 (47%) were similarly classified under the two definitions. Under the ATP III criteria, but not the IDF definition, 2 (1%) participants had MS, and 29 (11%) subjects had MS under the IDF definition but not the ATP III criteria (p=0.009). The ATP III criteria and the IDF definition were useful for identifying MS in adults with excess of adiposity; however, the IDF proposal identified a greater percentage of patients.

Effect of a nutritional liquid supplement designed for the patient with diabetes mellitus (Glucerna SR) on the postprandial glucose state, insulin secretion and insulin sensitivity in healthy subjects.

AIM: To identify the effect of a nutritional liquid supplement designed for the patient with diabetes mellitus (Glucerna SR) in single administration on the postprandial glucose state, insulin secretion and insulin sensitivity in healthy subjects. METHODS: A randomized, single-blind, cross-over, clinical trial was carried out in 14 young, healthy, non-obese, volunteers. A basal metabolic profile, which included glucose level, insulin, total cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides, creatinine, and uric acid, was measured. Subjects received a single administration of 300 kcal, gauged with water at 350 ml, of each of the following (at least 3 days apart): glucose 75 g, polymeric supplement (Ensure high calcium) 315 ml or Glucerna SR 323 ml. At the beginning of each administration and 30, 60, 90 and 120 min later, glucose and insulin concentrations were measured. Areas under the curve of glucose and insulin were calculated. First-phase and total insulin secretions and insulin sensitivity were also estimated. RESULTS: Glucose level at 120 min was significantly lower after receiving Ensure high calcium or Glucerna SR. Administration of Glucerna SR resulted in a significant reduction in the areas under the curve of glucose and insulin, as well as in total insulin secretion with a tendency to be lower in their first phase. Insulin sensitivity was increased. CONCLUSIONS: A single administration of Glucerna SR to healthy subjects decreased the postprandial glucose and insulin states, as well as the insulin secretion; insulin sensitivity increased.

Early decrease of the percent of HOMA beta-cell function is independently related to family history of diabetes in healthy young nonobese individuals.

OBJECTIVE: To determine the relationship between family history of diabetes (FHD) and decrease in percent of HOMA beta-cell function (HOMA-beta%) index in healthy betanon-obese Mexican subjects. MATERIALS AND METHODS: Forty-eight individuals (30 women and 18 men) with FHD were compared vs 48 control subjects (30 women and 18 men) in a cross-sectional study matched by age, sex, and Waist-to-Hip ratio. Pregnancy, obesity, being overweight, alcohol consumption, high blood pressure, and heavy physical activity were exclusion criteria. All the participants were required to have a Body Mass Index < 25 kg/m2 and serum fasting and 2-hours postload glucose levels lower than 6.1 mmol/l and 7.8 mmol/l, respectively. The reciprocal of serum fasting insulin concentrations (1/Ins0) (microU/ml) and HOMA-B% index were used as indicators of insulin sensitivity and beta-cell function. RESULTS: Average age was of 19.4 +/- 3.6 vs 19.8 +/- 2.6, P = 0.66 for the subjects with and without FHD. HOMA-beta% index was significantly lower in the subjects with FHD (186.1 +/- 74.1 vs 252.7 +/- 149.5, P = 0.01). For similar levels of insulin sensitivity, subjects with FHD showed lower HOMA-beta% index than control subjects (P < 0.001). Multivariate regression analysis showed a strong and independent relationship between FHD and decrease of HOMA-beta% index (OR 2.6, CI95% 1.2-4.3, P = 0.01). CONCLUSIONS: This study shows that normal-weight offspring of type 2 diabetes subjects exhibited a significant decrease of HOMA-beta% index suggesting that FHD exerts an independent early negative effect on beta-cell function.

Methylenetetrahydrofolate reductase C677T polymorphism and Factor V Leiden variant in Mexican women with preeclampsia/eclampsia.

The etiology of preeclampsia is still a matter of controversy. An association between hyperhomocysteinemia and preeclamptic patients has been described. A common missense mutation in the methylenetetrahydrofolate reductase (MTHFR) gene is associated with increased plasma homocysteine concentrations. In addition, the polymorphism of gene encoding for Factor V Leiden G1691A is associated with a prothrombotic state in heterozygous subjects. Both mutations in these thrombophilic proteins appear to have different prevalence in the general population and in patients with preeclampsia/eclampsia (PE/E). We studied single nucleotide polymorphisms for MTHFR C677T and coagulation Factor V Leiden in 33 Mexican patients with PE/E as a genetic risk factor for these diseases, comparing with a normotensive pregnant control group. The genotype and allele frequencies of MTHFR C677T and Factor V Leiden mutations between Mexican women with PE/E and healthy controls were not different. We conclude that these polymorphisms do not contribute in the etiology of PE/E as it has been reported in other populations.

Efecto de la administración oral de inulina sobre el perfil de lípidos y la sensibilidad a la insulina en individuos con obesidad y dislipidemia / Effect of oral inulin administration on lipid profile and insulin sensitivity in subjects with obesity and dyslipidemia

BACKGROUND: Inulin is a non absorbable polysaccharide with prebiotic effects, whose influence on blood lipids or insulin sensitivity is not well known: AIM: To assess the effect of oral administration of inulin on lipid profile and insulin sensitivity in dyslipidemic obese subjects. MATERIAL AND METHODS: A clinical trial, double blind, randomized with placebo was carried out in 12 obese, hypertrygliceridemic and hypercholesterolemic subjects between 19 and 32 years old. The subjects were randomized to receive 7 g/day of inulin or placebo in the morning, during 4 weeks. Biochemical and metabolic profiles and euglycemic-hyperinsulinemic clamp technique for assessing insulin sensitivity, before and after pharmacological intervention were performed. RESULTS: After inulin administration, there was a significant reduction of total cholesterol (248.7 +/- 30.5 and 194.3 +/- 39.8 mg/dL; p = 0.028), low density lipoprotein (LDL), cholesterol (136.0 +/- 27.8 and 113.0 +/- 36.2 mg/dL; p = 0.028), very low density lipoproteins (VLDL) (45.9 +/- 18.5 and 31.6 +/- 7.2 mg/dL; p = 0.046) and trygliceride concentrations (235.5 +/- 85.9 and 171.1 +/- 37.9 mg/dL; p = 0.046). No effect of inulin on insulin sensitivity was observed. CONCLUSIONS: The oral inulin administration reduced total cholesterol, LDL cholesterol, VLDL and trygliceride levels in dyslipidemic and obese subjects, without modifications in the insulin sensitivity.

Serum complement C3c concentration in non-obese young insulin-resistant Mexicans.

The aim of this study was to compare the serum complement C3 concentration between non-obese young insulin-sensitive and insulin-resistant Mexicans. A cross-sectional study was carried out in 28 healthy, non-obese [Body mass index (BMI) < 26 kg/m2] young (age 19-25 yr), male volunteers to measure the serum C3 concentration. In accordance with the constant for rate serum glucose disappearance (KITT) obtained from the insulin tolerance test, the subjects were divided into quartiles, considering as insulin-resistant individuals those in quartile 1, and insulin-sensitive subjects those in quartile 4. Serum C3c concentration was measured by a nephelometric method. Other biochemical characteristics were measured, like lipid profile and uric acid using enzymatic techniques. The serum C3 concentrations were similar (p = 0.949) between insulin-resistant and insulin-sensitive groups respectively (1.4 +/- 0.2 vs 1.3 +/- 0.1 g/l). There were no significant correlations between serum C3 concentrations and serum glucose, insulin levels, KITT and lipid profile. In conclusion, the serum complement C3c concentrations were similar between non-obese young insulin-sensitive and insulin-resistant Mexicans.

The effects of surgically removing subcutaneous fat on the metabolic profile and insulin sensitivity in obese women after large-volume liposuction treatment.

The aim of this study was to identify the effects of surgically removing subcutaneous fat on the metabolic profile and insulin sensitivity in obese women after large-volume liposuction treatment. An open clinical trial with a non-intervention parallel group was carried out on 12 young, obese women. After randomization, six volunteers were selected to the surgical intervention consisting of large-volume liposuction; the other six women were considered as the non-intervention group. Metabolic profiles and insulin tolerance tests to assess insulin sensitivity were performed on all volunteers before intervention or non-intervention and 21 - 28 days afterwards. There were a significant decrease in glucose (4.9 +/- 0.4 vs. 4.6 +/- 0.2 mmol/l, p < 0.05) and uric acid (250.8 +/- 56.2 vs. 224.0 +/- 53.4 micromol/l, p < 0.05) levels after liposuction; insulin sensitivity improved after the surgical intervention (4.3 +/- 0.9 vs. 5.3 +/- 0.8 %/min, p = 0.046). In conclusion, surgical removal of subcutaneous fat by large-volume liposuction led to an improvement in insulin sensitivity and a decrease in glucose and uric acid concentrations.

[Effect of hormone replacement therapy including a progestin on insulin sensitivity and lipid profile in postmenopausal women]. / Efecto de la terapia hormonal de reemplazo, que incluye un progestágeno, sobre la sensibilidad a la insulina y el perfil de lípidos en la mujer en etapa de posmenopausia.

BACKGROUND: The cardiovascular protective properties of hormone replacement therapy can be hampered when a progestin is used. AIM: To assess the effects of hormone replacement therapy with progestins on insulin sensitivity and lipid profile. PATIENTS AND METHODS: Twelve healthy postmenopausal women aged 45 to 55 years old were studied. Blood lipids and insulin sensitivity, determined using the insulin tolerance test, were measured at baseline and after three months of hormone replacement therapy using conjugated estrogens, 0.625 mg/day and medroxyprogesterone acetate, 5 mg/day. RESULTS: The glucose disappearance constant was higher after the treatment period than at baseline (5.3 +/- 0.8 and 4.7 +/- 0.8%/min respectively, p = 0.005). Serum LDL cholesterol was also lower at the end of treatment period (124.5 +/- 30.2 and 140 +/- 25.4 mg/dl respectively, p = 0.019). CONCLUSIONS: In this group of postmenopausal women, a period of three months of hormone replacement therapy with a progestin improved insulin sensitivity and lowered LDL cholesterol levels.

Renal handling of uric acid assessed by means of pharmacological tests in obese women.

The aim of this study was to compare the renal handling of uric acid by means of pyrazinamide and probenecid tests between obese and non-obese women. A cross-sectional study was carried out in 8 obese women and in 8 non-obese women as control group. Metabolic profile and renal handling of uric acid including clearance, fractional excretion and excretion rates, were assessed. Due to technical problems, pyrazinamide and probenecid tests were performed only in 5 women of each group to evaluate presecretory reabsorption, secretion and post-secretory reabsorption of uric acid. Uric acid clearance had a tendency to be lower in the obese women than in the control group. There were no significant differences between the groups in fractional excretion and excretion uric acid rates. Pre- and post-secretory reabsorptions of uric acid did not differ between the obese and the non-obese women. Tubular secretion of uric acid was significantly lower in the obese women compared with the control group (6.4 vs 13.6%; p=0.02). Tubular secretion of uric acid negatively correlated with body mass index (r=-0.73; p<0.05). In conclusion, tubular secretion of uric acid possibly plays an important role in uric acid homeostasis in obese women.

Insulin action and secretion in healthy Hispanic-Mexican first-degree relatives of subjects with type 2 diabetes.

The aim of this study was to assess the early insulin secretion and insulin action of healthy non-diabetic Hispanic-Mexican subjects with and without family history of Type 2 diabetes (FHD). One hundred and twenty non-relative subjects were compared against 115 first-degree relatives of individuals with Type 2 diabetes. To assign the subjects to the correspondent group, the FHD was carefully ascertained by clinical examination of the participants' parents. Age and gender were matched criteria. Incomplete or unclear data about FHD, previous diagnosis of diabetes or chronic diseases were exclusion criteria. Subjects in both groups were required to have fasting glucose <6.1 mmol/l, and 2-h PG<7.7 mmol/l. Insulin action and secretion were estimated by HOMA (homeostasis model insulin analysis resistance index) and insulinogenic index, respectively. Logistic regression analysis showed an independent relationship between BMI and insulin resistance (HOMA score >5.0) (odds ratio, OR, 1.42, p=0.03), and between FHD and insulin resistance (OR 1.27, p=0.04). On the other hand, there was a strong and independent relationship between FHD and high early insulin secretion (insulinogenic index >0.72) (OR 1.64, p=0.01) but not between BMI and high early insulin secretion (OR 0.93, p=0.3). Healthy Mexican first-degree relatives of subjects with Type 2 diabetes show an independent relationship between FHD and both high early insulin response and decreased insulin action, whereas BMI was only related to insulin resistance.

Effect of glycine on insulin secretion and action in healthy first-degree relatives of type 2 diabetes mellitus patients.

The aim of this study was to identify the effect of glycine on insulin secretion and action in healthy first-degree relatives of Type 2 diabetes mellitus patients. A randomized, double-blind, placebo-controlled clinical trial was performed in 12 healthy, non-obese volunteers who were first-degree relatives of Type 2 diabetes mellitus patients. Six volunteers received a morning dose of glycine 5 g orally and the other six received placebo. At baseline without drugs and after pharmacological intervention, a metabolic profile and, to assess insulin secretion and action, a hyperglycemic-hyperinsulinemic clamp study were performed. There were no significant differences in baseline metabolic profile, insulin secretion or action between groups. Changes from baseline of early (p < 0.05), late (p < 0.05), and total insulin (p < 0.02) responses were higher in the glycine group than in controls. There were no significant differences in the changes from baseline of insulin action between groups. In conclusion, a morning dose of glycine 5 g orally increased early, late and total insulin responses without changes in insulin action in healthy first-degree relatives of Type 2 diabetes mellitus patients.

Association of adiposity assessed by means of near-infrared interactance with the beta-cell function, insulin resistance and leptin concentrations in non-obese subjects. Exploratory study.

The objective was to identify the association of adiposity with the beta-cell function, insulin resistance and leptin concentrations in non-obese subjects. Twenty-eight healthy, non-obese volunteers were recruited, 14 male and 14 female. Body mass index (BMI) and waist hip ratio (WHR) were calculated. Blood pressure was measured. Adiposity was estimated by means of near-infrared (NIR) interactance method predicting the percentage of body fat (% BF). All subjects were divided into adipose and non-adipose individuals. Serum glucose, insulin and leptin levels were measured. Formulas of the homeostasis model analysis were used to assess the insulin resistance and the beta-cell function. Clinical characteristics and laboratory profile were similar between both groups. There were no significant differences between both groups in beta-cell function, insulin resistance and leptin concentrations. There was a positive significant correlation of % BF with BMI in women (r= .82, P< .001) and in men (r= .85, P< .001). Adiposity was not associated with the beta-cell function, insulin resistance and leptin concentrations in non-obese subjects, and only percent body fat was positive correlated with BMI.

Weight, physical activity, and smoking as determinants of insulinemia in adolescents.

BACKGROUND: It is known that insulinemia is the result of the interaction among several factors, such as weight, body fat pattern distribution, and physical activity as well as ethnicity. There is little information regarding this question among Mexican adolescents. The association among fasting insulin levels, weight, fat distribution, physical activity, and cigarette smoking was studied in Mexican adolescents. METHODS: Cross-sectional data were collected from 352 Mexican adolescents aged 14-19 years (response rate 41.5%). Fasting insulin levels were measured by microparticle enzyme immunoassay; body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC) were determined using standardized techniques, while physical activity was determined by 7-day Stanford physical activity inventory. Cigarette smoking was defined as number of cigarettes/year. RESULTS: Increased BMI and waist circumference, low physical activity, younger age, and non-smoking were associated with high insulin levels. Non-smokers had higher fasting insulin levels compared to smokers (57.8 pmol +/- 1.84 vs. 49.7 pmol/L +/- 2.8; p = 0.034). However, adjusted odds ratio (OR) between insulin and smoking status was not significant. Multivariate analysis showed the following: insulin increased 1.06 pmol/L for each unit of change in BMI; increased 1.02 pmol/L for each unit of change in waist circumference; increased 1.16 pmol/L for non-smoking, and decreased 1.07 pmol/L for each 250 kcal/day of energy expenditure. CONCLUSIONS: Our results support the concept that Mexican adolescents who are overweight have abdominal fat distribution and physical inactivity, and significant hyperinsulinemia. The relationship between smoking and lower insulinemia found in this research warrants further study.

Inhibition of cyclooxygenase-1 or -2 on insulin sensitivity in healthy subjects.

The aim of this study was to identify the effects of cyclooxygenase (COX)-1 and -2 inhibition each on insulin sensitivity in healthy subjects. A randomized, double-blind, controlled clinical trial was carried out in 21 young, healthy, non-obese male volunteers. Pharmacological COX-1 inhibition was performed with the prescription of acetylsalicylic acid (ASA) at a low dose, and COX-2 selective inhibition was performed with celecoxib. After randomization, all subjects received an oral morning dose of ASA 100 mg (n = 7), celecoxib 200 mg (n = 7), or placebo for the control group (n = 7) during a period of 15 days. Before and after of the study period, a metabolic profile was measured in all participants. An insulin tolerance test (ITT) was performed to assess insulin sensitivity, and the constant for the serum glucose disappearance rate (K ITT) was calculated. Clinical and metabolic characteristics were similar between groups. The K ITT calculated with the ITT was higher after celecoxib than at baseline (4.8 +/- 0.9 vs. 4.3 +/- 0.6%/min, p = 0.04), indicating improvement in insulin sensitivity. Neither ASA nor placebo administrations modified insulin sensitivity. In conclusion, COX-2-selective inhibitor at a celecoxib dose of 200 mg daily increased insulin sensitivity in healthy subjects.

[Correlation between leptin and insulin levels in preeclampsia. Study in Mexican mestizo population]. / Relación leptina-insulina en preeclampsia. Estudio en población mestiza mexicana.

BACKGROUND: Serum leptin levels increase during pregnancy and this increase is more pronounced in women with preeclampsia. AIM: To determine if there is a significant correlation of serum leptin with insulin and glucose levels in normotensive pregnant women and in preeclampsia patients. MATERIAL AND METHODS: A nested case-control study in 16 normotensive pregnant women and in 16 preeclampsia mestizo Mexicans in the third trimester of the gestation matched by age, gestational age and pre gestational body mass index. Venous blood samples after at least 6 h fast, were obtained and stored at -70 degrees C to measure serum leptin levels by ELISA, insulin concentrations by RIA and glucose by the glucose oxidase technique. RESULTS: There were no differences between normotensive women and those with preeclampsia in serum leptin, insulin and glucose levels. There was a positive correlation between leptin and insulin concentrations (p = 0.005), a negative correlation between leptin and glucose levels (p = 0.02) and no correlation between leptin and pre gestational body mass index. CONCLUSIONS: In this study, women with preeclampsia did not have higher leptin levels than normotensive pregnant women.

[Effect of oral administration of ascorbic acid on insulin sensitivity and lipid profile in obese individuals]. / Efecto de la administración oral de ácido ascórbico sobre la sensibilidad a la insulina y el perfil de lípidos en individuos con obesidad.

BACKGROUND: The aim of this study was to identify the effect of an oral ascorbic acid (AA) supplement on lipid profile and insulin sensitivity in obese people. RESEARCH DESIGN AND METHODS: A randomized double-blind clinical trial placebo controlled was performed in 16 obese male volunteers [body mass index (BMI) 30-40 kg/m2]. Eight received orally 1 g of AA daily for four weeks and the other eight volunteers received placebo by the same scheme and period of time. Before and after the pharmacological intervention were measured total cholesterol, high-density-lipoprotein (HDL) cholesterol, triglycerides, glucose, creatinine and uric acid. Low-density-lipoprotein (LDL) cholesterol and very-low-density-lipoprotein (VLDL) triglycerides were calculated using formulas. In order to assess insulin sensitivity before and after the intervention, the steady-state glucose (SSG) was calculated from the insulin suppression test modified with octreotide. RESULTS: There were not significant differences in clinical characteristics between both groups. Basal metabolic profile and SSG were similar between both groups. There were not significant differences in both groups between before and after the intervention in metabolic profile and insulin sensitivity. CONCLUSION: AA did not modify the lipid profile nor insulin sensitivity in the group of obese people studied.

Effects of behavior-modifying education in the metabolic profile of the type 2 diabetes mellitus patient.

To demonstrate the advantages of behavior-modifying education in the metabolic profile of the type-2 diabetes mellitus patient. A quasi-experimental study was performed with a control group. The experimental group was made up of 25 type-2 diabetic patients and the control group consisted of 24. The type of education carried out was a behavior modification. Baseline measurements and subsequent monthly measurements of serum glucose, total cholesterol and triglycerides were carried out during 9 months after the intervention. The groups were controlled according to age and sex. The statistical analysis was performed using the Student's and Wilcoxon's test to determine the difference. The experimental group in comparison with the control group in the measurement after the intervention achieved a mean difference in serum glucose of 64.2 mg/dl (p=0.001), in the cholesterol of 31.6 (p=0.008), and in the triglycerides of 50.8 (p=0.006). The behavior-modifying education is a better option than traditional intervention for metabolic control in type-2 diabetes mellitus patients.

Serum leptin levels and the severity of preeclampsia.

The aim of this study was to evaluate the serum leptin levels in preeclampsia patients and in normotensive pregnant women, as well as, to assess an association with the severity of the disease. A cross-sectional study was carried out in 14 patients with mild preeclampsia, 12 with severe preeclampsia, and in 32 normotensive pregnant women during the third trimester of pregnancy. Rigorous criteria of selection were considered. The leptin levels were tested by an enzyme-linked immunosorbent method. There were no significant differences in serum leptin concentrations between the patients with mild preeclampsia [13.6 +/- 11.2 (95% CI, 7.7-19.4) ng/mL], severe preeclampsia [14.8 +/- 11.5 (95% CI, 8.2-21.3) ng/mL] and normotensive pregnant women [12.5 +/- 7.9 (95% CI, 9.7-15.2) ng/mL]. In conclusion, serum leptin levels were similar in the patients with different grades of preeclampsia and normotensive pregnant women.