Insulin resistance and androgens in healthy women with different body fat distributions.

OBJECTIVE: To compare androgens and sex hormone-binding globulin (SHBG) levels, and indices of insulin sensitivity (the response of plasma insulin and C-peptide in OGTT, insulin resistance and beta-cell activity estimated with the homeostasis assessment model (HOMA model) in healthy obese premenopausal women with different body fat distributions. PATIENTS AND METHODS: Free testosterone, androstenedione, SHBG levels and responses of plasma glucose, insulin and C-peptide in OGTT were examined in 74 healthy premenopausal women (19 with lower-body obesity (WHR < 0.80), 20 with pure abdominal obesity (WHR > 0.85), 19 with predominant abdominal obesity (WHR 0.81-0.85) and 18 normal-weight women). Insulin resistance and beta-cell function were estimated with the HOMA model. RESULTS: Both fasting and glucose-induced insulin levels were higher in women with pure abdominal obesity than in the controls (p < 0.001) and in those with lower-body obesity (P < 0.01). Insulin resistance was also higher in women with pure abdominal obesity than in the controls (p < 0.01) and those with lower-body obesity (p < 0.05). Free testosterone (p < 0.01) was higher and SHBG (p < 0.001) was lower in women with abdominal obesity than in the control group and those with lower-body obesity. Insulin significantly correlated with SHBG, and this correlation was independent of androgens, obesity and obesity type. Beta-cell function positively correlated with free testosterone, whereas insulin resistance negatively correlated with SHBG, and was independent of obesity and obesity type. CONCLUSIONS: In healthy premenopausal women, increased BMI and more pronounced abdominal fat accumulation was associated with increased androgenic activity (higher free testosterone and lower SHBG levels) and with insulin resistance estimated using the HOMA model, as well as with increasing basal and glucose-induced insulin levels. SHBG levels correlated with insulin and insulin resistance independently of the degree of obesity, obesity type and androgens, whereas beta-cell function correlated only with free testosterone.

Patient acceptance and reliability of new Humulin/Humalog 3.0 ml prefilled insulin pen in ten Croatian diabetes centres.

BACKGROUND: The objective of this study was to assess feature preferences, patient acceptance, reliability, and safety of the new Lilly Humulin/Humalog 3.0 ml prefilled insulin pen in a clinical setting. MATERIAL/METHODS: A total of 330 patients in Croatia with type 1 or type 2 diabetes mellitus who required at least one injection of insulin per day were treated with Humulin 30/70 or Humalog for 4 to 6 weeks using the new prefilled pen. Questionnaires concerning various aspects of the pen performance were administered at endpoint. RESULTS: The features of the Lilly 3.0 ml pen device ranked most highly by patients (% of excellent or good ratings) were cartridge visibility (93%), attaching/replacing needles (93%), ease of dose correction (92%), checking insulin flow (90%) and dialling of insulin dose (89%). Features of the pen device rated most highly by patients in comparison with the delivery systems used before the study and the percentage of patients rating those features as much better or better were ease of dose correction (74%), cartridge visibility (67%), audible dialing clicks (55%) and size of dose numbers (52%). Most respondents (78%) preferred single-unit versus two-unit dosage increments. The majority of patients rated the new prefilled pen as being more convenient and easier to use, and indicated that it represented a significant or modest an improvement over their previous insulin injection method. CONCLUSIONS: The results of this study indicate that the new Lilly 3.0 ml prefilled pen is acceptable for patients who were previously using either reusable devices or the traditional syringe and vial.