Metabolic Effects of Betaine: A Randomized Clinical Trial of Betaine Supplementation in Prediabetes.

Context: Plasma betaine correlates with insulin sensitivity in humans. Betaine supplementation improves metabolic effects in mice fed a high-fat diet. Objective: To assess metabolic effects of oral betaine in obese participants with prediabetes. Design: A 12-week, parallel arm, randomized, double-masked, placebo-controlled trial. Setting: University-affiliated hospital. Participants and Interventions: Persons with obesity and prediabetes (N = 27) were randomly assigned to receive betaine 3300 mg orally twice daily for 10 days, then 4950 mg twice daily for 12 weeks, or placebo. Main Outcome Measures: Changes from baseline in insulin sensitivity, glycemia, hepatic fat, and endothelial function. Results: There was a 16.5-fold increase in plasma dimethylglycine [dimethylglycine (DMG); P < 0.0001] levels, but modest 1.3- and 1.5-fold increases in downstream serine and methionine levels, respectively, in the betaine vs placebo arm. Betaine tended to reduce fasting glucose levels (P = 0.08 vs placebo) but had no other effect on glycemia. Insulin area under curve after oral glucose was reduced for betaine treatment compared with placebo (P = 0.038). Insulin sensitivity, assessed by euglycemic hyperinsulinemic clamp, was not improved. Serum total cholesterol levels increased after betaine treatment compared with placebo (P = 0.032). There were no differences in change in intrahepatic triglyceride or endothelial function between groups. Conclusion: DMG accumulation supports DMG dehydrogenase as rate limiting for betaine metabolism in persons with prediabetes. Betaine had little metabolic effect. Additional studies may elucidate mechanisms contributing to differences between preclinical and human responses to betaine, and whether supplementation of metabolites downstream of DMG improves metabolism.

Risk of Type 2 Diabetes Is Lower in US Adults Taking Chromium-Containing Supplements.

BACKGROUND: Dietary supplement use is widespread in the United States. Although it has been suggested in both in vitro and small in vivo human studies that chromium has potentially beneficial effects in type 2 diabetes (T2D), chromium supplementation in diabetes has not been investigated at the population level. OBJECTIVE: The objective of this study was to examine the use and potential benefits of chromium supplementation in T2D by examining NHANES data. METHODS: An individual was defined as having diabetes if he or she had a glycated hemoglobin (HbA1c) value of ≥6.5%, or reported having been diagnosed with diabetes. Data on all consumed dietary supplements from the NHANES database were analyzed, with the OR of having diabetes as the main outcome of interest based on chromium supplement use. RESULTS: The NHANES for the years 1999-2010 included information on 62,160 individuals. After filtering the database for the required covariates (gender, ethnicity, socioeconomic status, body mass index, diabetes diagnosis, supplement usage, and laboratory HbA1c values), and when restricted to adults, the study cohort included 28,539 people. A total of 58.3% of people reported consuming a dietary supplement in the previous 30 d, 28.8% reported consuming a dietary supplement that contained chromium, and 0.7% consumed supplements that had "chromium" in the title. Compared with nonusers, the odds of having T2D (HbA1c ≥6.5%) were lower in persons who consumed chromium-containing supplements within the previous 30 d than in those who did not (OR: 0.73; 95% CI: 0.62, 0.86; P = 0.001). Supplement use alone (without chromium) did not influence the odds of having T2D (OR: 0.89; 95% CI: 0.77, 1.03; P = 0.11). CONCLUSIONS: Over one-half the adult US population consumes nutritional supplements, and over one-quarter consumes supplemental chromium. The odds of having T2D were lower in those who, in the previous 30 d, had consumed supplements containing chromium. Given the magnitude of exposure, studies on safety and efficacy are warranted.

Cáncer de tiroides y síndromes polipósicos intestinales Síndrome de Gardner / Thyroid cancer and intestinal polyposis syndromes Gardner syndrome

Resumen Presentamos el caso de una mujer de 22 años de edad, evaluada debido a que en su historia familiar a su madre se le encontró carcinoma de colon sigmoide. A la paciente se le diagnosticó poliposis colónica, que resolvió tras remoción endoscópica de las lesiones. Se realizó estudio de nódulo tiroideo y se realizó tiroidectomía total encontrándose un carcinoma papilar de tiroides como diagnóstico definitivo. Hicimos una revisión de la literatura. (Acta Med Colomb 2013; 38: 182-185).

Abstract We report the case of a 22-year-old woman evaluated because in her family history his mother had a sigmoid colon carcinoma. The patient was diagnosed with colonic polyposis, which resolved after endoscopic removal of the lesions. We made the study of a thyroid nodule and performed total finding a papillary thyroid carcinoma as definitive diagnosis. (Acta Med Colomb 2013; 38: 182-185).

Factores asociados con el control glucémico óptimo en pacientes tratados con bomba de insulina y monitorización continua de glucosa en tiempo real / Factors associated with optimal glycemic control in patients with insulin pump therapy and continuous glucose monitoring in real time

OBJETIVO: Cuando se utiliza monitorización continua de glucosa (MCG) y algoritmos de estimación de bolos, muchos pacientes en terapia con bomba de insulina alcanzan euglucemia. Evaluamos patrones de uso en integración de tecnología de bomba/MCG asociados con niveles de HbA1c < 7%. MÉTODOS: Analizamos datos de 217 pacientes (edad > 11 años; 53,5% hombres; 91,7% con diabetes tipo 1; > 3 meses de experiencia en bomba) en manejo en un hospital universitario de Bogotá, Colombia, incluyendo aplicación de insulina, HbA1c, eventos hipoglucémicos severos, uso de MCG, culminación de cursos educativos en diabetes y frecuencia de glucometrías. Todos los pacientes recibieron entrenamiento para uso de bomba y la mayoría (73,7%) entrenamiento adicional en conteo de hidratos de carbono, ajustes de tasa basal y uso de datos de MCG. RESULTADOS: El inicio de terapia con bomba se asoció a disminución de HbA1c, uso de insulina y eventos hipoglucémicos severos (p < 0,001). Conductas específicas con bomba-MCG asociadas con menor A1c incluyeron uso de algoritmos de estimación de dosis en > 80% de los bolos y uso de sensor MCG > 80% del tiempo (p < 0,005). HbA1c menor se evidenció con culminación del entrenamiento adicional, edad > 18 años, uso de bomba Paradigm 722 con MCG integrado, uso de alarmas por MCG, HbA1c > 7% antes de terapia y controles de glucemia capilar más frecuentes (p < 0,05). Muchos pacientes (45,6%) alcanzaron HbA1c ≤ 7% con bomba. CONCLUSIONES: La educación, combinada con uso consistente de sensores-MCG y algoritmos de bolos confiere reducciones de HbA1c mayores a las alcanzadas con la terapia solamente con bomba

OBJECTIVE: When used with continuous glucose monitoring (CGM) and bolus estimation algorithms, many patients on insulin pump therapy achieve near-euglycemia. We evaluated the usage patterns of integrated pump/CGM technology that are associated with A1C levels < 7%. METHODS: Data from 217 patients (age > 11 years, 53.5% male, 91.7% with type 1 diabetes, all with > 3 months pump experience) receiving care at a teaching hospital in Bogotá, Colombia, were analyzed. Data included insulin delivery, A1C levels, severe hypoglycemic events, use of CGM, completion of diabetes education courses, and the frequency of blood glucose checks. All patients received training on the use of the pump, and most (73.7%) received additional training on carbohydrate counting, basal rate adjustments, and use of CGM data. RESULTS: Initiation of pump therapy was associated with decreases in A1C, insulin use, and severe hypoglycemic events (all P <0 .001). Pump and CGM-specific behaviors associated with lower A1C included the use of a dose estimation algorithm for > 80% of bolus doses and use of CGM sensors > 80% of the time (both P <0 .005). Lower A1C was also associated with the completion of additional training, age > 18, use of the Paradigm 722 pump with an integrated CGM device, use of CGM-based alarms, A1c >7% before pump therapy, and more frequent blood glucose checks (all P < 0.05). Many (45.6%) patients reached A1c ≤ 7% with pump therapy. CONCLUSIONS: Patient education, with an A1c below 7% before sensor-augmented pump therapy, when combined with consistent use of CGM sensors and bolus estimation algorithms, leads to favorable reductions in A1C beyond those achieved with pump therapy alone