Contribution of Insulin Resistance and ß Cell Dysfunction to Gestational Diabetes Stratified for Pre-pregnant Body Mass Index.

The objective of the study was to evaluate the contribution of insulin resistance and ß cell dysfunction to gestational diabetes mellitus (GDM) in Chinese women stratified by pre-pregnant body mass index (BMI). A total of 847 pregnant women were enrolled. They were divided into low BMI and high BMI groups according to the median of pre-pregnancy BMI. The homeostasis model assessment of insulin resistance (HOMA-IR) and ß cell function (HOMA-ß), Matsuda index, and 60-min insulinogenic index (IGI60) were used to evaluate insulin resistance and ß cell function. In all the participants, 150 (17.71%) were diagnosed with GDM. ROC analyses showed that in the low BMI group, the association of ß cell dysfunction (IGI60 or HOMA-ß) with GDM was stronger than that of insulin resistance (Matsuda index or HOMA-IR), while in the high BMI group, the association of ß cell dysfunction with GDM was weaker than that of insulin resistance (all P < 0.05). Among all GDM patients, 47.33% demonstrated predominant insulin resistance (Matsuda index < 25th percentile), and 46% had predominant ß cell defect (IGI60 < 25th percentile). In the low BMI group, 15.09% of GDM patients demonstrated predominant insulin resistance, and 62.26% of GDM patients had predominant ß cell defect, whereas in the high BMI group, 64.95% of GDM patients demonstrated mainly insulin resistance and 36.08% of GDM patients had mainly ß cell defect. In women with low BMI, ß cell dysfunction is the major etiologic factor, whereas, in women with high BMI, insulin resistance is the predominant etiologic factor in the development of GDM.

The Association Between Low T3 Syndrome and Survival in Patients With Newly Diagnosed Multiple Myeloma: A Retrospective Study.

Objective: The correlation between low triiodothyronine (T3) syndrome and shorter survival in malignant tumor patients has been increasingly reported. The objective of the present study was to investigate the association between low T3 syndrome and survival in multiple myeloma (MM) patients. Methods: A total of 201 newly diagnosed MM patients were included in this retrospective study. All participants were divided into 2 groups based on serum free T3 (FT3) level: low T3 syndrome group (FT3 < 2.3 pg/mL) and non-low T3 syndrome group (FT3 ≥ 2.3 pg/mL). Baseline clinical characteristics, overall survival (OS) and progression free survival (PFS) were analyzed. Results: 80 (39.8%) patients had low T3 syndrome. Patients with low T3 syndrome had significantly lower blood hemoglobin and albumin, higher creatinine and ß2-microglobulin (ß2-MG), higher neutrophil/lymphocyte and (neutrophil + monocyte)/lymphocyte ratio, and more advanced ISS and R-ISS stages (all P < .05). Serum FT3 level was positively associated with blood hemoglobin and albumin, and negatively correlated with ß2-MG, creatinine, neutrophil/lymphocyte ratio, and (neutrophil + monocyte)/lymphocyte ratio (all P < .05). Patients with low T3 syndrome had significantly inferior OS time and PFS time (both P < .001). In multivariate Cox analysis, low T3 syndrome was found to be an independent factor associated with OS (P < .001) and PFS (P = .002). Receiver operator characteristic curve analyses showed that FT3 was a predictive marker for death during the entire follow-up period (the area under the curve [AUC] = 0.720, P < .001) and during 1 year (AUC = 0.747, P < .001). Conclusion: Low T3 syndrome might be useful for predicting survival in patients with newly diagnosed MM.

Sex Difference in the Association Between Neutrophil to Lymphocyte Ratio and Severity of Coronary Artery Disease.

The neutrophil to lymphocyte ratio (NLR) is a predictor of cardiovascular risk. However, little was known about the influence of sex in this relationship. The present study was designed to evaluate the association between NLR and coronary artery disease (CAD) risk and severity in males and females. A total of 810 patients (478 males and 332 females) who had undergone coronary angiography at the Beijing Chaoyang Hospital were enrolled. CAD severity was evaluated using the Gensini and SYNTAX scores. For males, the NLR was higher in CAD patients than that in non-CAD patients (all P < .001). But there was no significant difference in NLR between female CAD and non-CAD patients (P = .222). The NLR correlated with the Gensini and SYNTAX scores in male CAD patients (both P < .001), but this correlation was not found in female counterparts (both P > .10). Logistic regression analyses and receiver operator characteristic curve (ROC) analyses showed that the NLR was an independent risk factor and a predictor of CAD in males (both P < .01) but not in females (both P > .10). In conclusion, the NLR was closely related to the presence and severity of CAD in males but not in females.

Relation of kidney function and homocysteine in patients with hypothyroidism.

OBJECTIVE: It has been found that both serum homocysteine (Hcy) and serum creatinine levels were increased in hypothyroidism patients. The aim of this study was to investigate the correlation between serum Hcy and kidney function in patients with subclinical hypothyroidism or hypothyroidism. METHODS: A total of 448 subjects were enrolled and divided into three groups: hypothyroidism (n = 129), subclinical hypothyroidism (n = 141), and control group (n = 168). Anthropometric information, metabolic parameters, serum Hcy and creatinine levels, and estimated glomerular filtration rate (eGFR) were analyzed. RESULTS: Compared with healthy subjects, patients with subclinical hypothyroidism or hypothyroidism had significantly higher serum Hcy and creatinine levels and lower eGFR level (all P < 0.001). Serum Hcy was negatively correlated with eGFR in subclinical hypothyroidism patients (r = -0.220, P = 0.009), and in hypothyroidism patients (r = -0.422, P < 0.001). After adjusting for age, sex and BMI, eGFR was still significantly correlated with serum Hcy in subclinical hypothyroidism or hypothyroidism patients (both P < 0.05). Levothyroxine treatment resulted in significantly decreased Hcy and increased eGFR in hypothyroidism patients (both P < 0.001). The decrease in Hcy was correlated with the increased eGFR after treatment (P = 0.001). CONCLUSION: Serum Hcy was negatively correlated with eGFR in subclinical hypothyroidism or hypothyroidism patients. After levothyroxine treatment, a correlation was found between the decrease in serum Hcy and the increase in eGFR in hypothyroidism patients.

The Prevalence of Euthyroid Hypertriiodothyroninemia in Newly Diagnosed Multiple Myeloma and its Clinical Characteristics.

OBJECTIVE: To evaluate the prevalence of euthyroid hypertriiodothyroninemia and/or hyperthyroxinemia and its clinical characteristics in multiple myeloma (MM) patients. METHODS: Previously untreated, newly diagnosed patients with MM were enrolled at the Beijing Chao-yang Hospital between January 2016 and December 2019. Thyroid function and clinical characteristics were analyzed. RESULTS: A total of 105 patients were enrolled in this study. Thirteen (12.38%) patients exhibited euthyroid hypertriiodothyroninemia with strikingly elevated total triiodothyronine (TT3) levels (>8 ng/mL). Among these 13 patients, 12 patients were immunoglobulin (Ig) G type (92.31%), and 1 patient was light-chain κ type (7.69%). Compared with other patients with MM, patients with hypertriiodothyroninemia were more likely to be IgG type and had higher serum globulin and lower albumin levels and more advanced International Staging System stage (all P < .05). Among the 13 euthyroid hypertriiodothyroninemia patients, 8 patients have been followed up and checked for thyroid function. The TT3 levels in all 8 patients were normalized to the reference range after antimyeloma chemotherapy. CONCLUSION: About 12% of patients with MM had euthyroid hypertriiodothyroninemia. Their strikingly elevated TT3 was normalized after chemotherapy. Clinicians should be aware of the possibility of high TT3 levels in euthyroid patients with MM and the potential risk of MM in patients with strikingly elevated TT3.

The association between albuminuria and thyroid antibodies in newly diagnosed type 2 diabetes mellitus patients with Hashimoto's thyroiditis and euthyroidism.

BACKGROUND: Microalbuminuria is a prognostic marker of diabetes kidney disease. It is generally diagnosed as the ratio of urinary albumin to creatinine (UACR) of 30-300 mg/g. Hashimoto's thyroiditis is a common disease in the endocrinology and the thyroid antibodies may associated with kidney disease. We investigated the UACR in the newly diagnosed T2DM with Hashimoto's thyroiditis and tried to detect the relationship between the UACR and thyroid antibodies. METHODS: One hundred twenty newly diagnosed T2DM patients with Hashimoto's thyroiditis and euthyroidism and 50 sex and age-matched T2DM with non-Hashimoto's and other thyroid disease were recruited. T2DM patients were divided into 2 groups by the titer of TPOAb: (1). TPOAb (+) group: T2DM with positive TPOAb (n = 105); (2). TPOAb (-) group: T2DM with negative TPOAb (n = 65). RESULTS: T2DM with positive TPOAb group had higher UACR than T2DM with negative TPOAb group (21.55 ± 7.28 vs 15.13 ± 5.69 mg/g, P < 0.01). UACR were positively related to BMI (r = 0.255, P < 0.05), FPG (r = 0.285, P < 0.05), HbA1c (r = 0.260, P < 0.05) and TPOAb (r = 0.349, P < 0.05). HbA1c (ß = 0.793, P < 0.05), BMI (ß = 0.342, P < 0.05) and lnTPOAb (ß = 1.207, P < 0.05) were independently associated with UACR. CONCLUSIONS: In the newly diagnosed T2DM patients, Hashimoto's thyroiditis with TPOAb positive had higher UACR levels. TPOAb titer, BMI and HbA1c were independent associated with UACR in these patients.

The Association Between Hyperhomocysteinemia and Thyroid Nodule Prevalence in an Adult Population.

Background: Thyroid nodule is the most common disorder of thyroid. Metabolic syndrome was regarded as an important factor for the prevalence of thyroid nodule. Homocysteine has been shown to be related to metabolic syndrome, inflammation, and several common cancers. In this study, we aimed to investigate the relationship between serum homocysteine and the prevalence of thyroid nodule. Materials and Methods: This was a cross-sectional study that included 2040 adults in a health checkup population in Beijing Chao-yang hospital. Thyroid ultrasound data, together with anthropometric characteristics, metabolic parameters, and serum homocysteine, were recorded respectively. Results: Hyperhomocysteinemia (defined as serum homocysteine ≥15 µmol/L) was detected in 452 participants (21.91%). Thyroid nodule prevalence was significantly higher in hyperhomocysteinemia participants than in normal homocysteine participants (52.57% vs. 45.16%, P = 0.006). Logistic regression analysis revealed that age [odds ratio (OR) 1.054; P < 0.001], female gender (OR 2.242; P < 0.001), body mass index (OR 1.050; P < 0.001), and serum homocysteine level (OR 1.022; P = 0.001) were the independent risk factors for thyroid nodule. Conclusions: Subjects with hyperhomocysteinemia have significantly higher thyroid nodule prevalence. Homocysteine is an independent risk factor for thyroid nodule. It implies that individuals with hyperhomocysteinemia have higher susceptibility to thyroid nodule.

Metformin or Acarbose Treatment Significantly Reduced Albuminuria in Patients with Newly Diagnosed Type 2 Diabetes Mellitus and Low-Grade Albuminuria.

BACKGROUND A urine albumin to creatinine ratio (UACR) >30 mg/g is considered to represent albuminuria, but in type 2 diabetes mellitus, even low-grade albuminuria is associated with increased risk of cardiovascular disease. This study aimed to investigate the effects of metformin and acarbose treatment on urine albumin excretion in Chinese patients with newly diagnosed diabetes and low-grade albuminuria. MATERIAL AND METHODS Patients with newly diagnosed diabetes (n=589) were divided into Group I (with a baseline UACR <10 mg/g) (n=331), and Group II (with a baseline UACR of 10-30 mg/g) (n=258). Following 48 weeks of treatment with metformin or acarbose, the UACR, blood pressure, body mass index (BMI), blood glucose, lipid profiles, and homeostasis model assessment of insulin resistance (HOMA-IR) were compared. RESULTS Baseline diastolic blood pressure, levels of blood glucose and low-density lipoprotein cholesterol (LDL-C), and HOMA-IR were significantly increased in Group II compared with Group I (all P<0.05). In Group II, both metformin and acarbose treatment significantly reduced the UACR (P<0.001); the effect was significantly greater following acarbose treatment compared with metformin treatment (P<0.05). In Group I, neither metformin nor acarbose treatment significantly changed the UACR, but both Group I and Group II showed a significant and comparable reduction in BMI, blood glucose, blood pressure, and HOMA-IR. CONCLUSIONS In a group of Chinese patients with newly diagnosed type 2 diabetes mellitus, low-grade albuminuria (baseline UACR of 10-30 mg/g) was associated with metabolic factors before treatment. Treatment with either metformin or acarbose significantly reduced albumin excretion.

Comparison of Acarbose and Metformin on Albumin Excretion in Patients With Newly Diagnosed Type 2 Diabetes: A Randomized Controlled Trial.

Increased urinary albumin excretion in diabetes not only signals nephropathy but also serves as a risk marker for cardiovascular disease. The data of MARCH (Metformin and AcaRbose in Chinese as the initial Hypoglycaemic treatment) trial demonstrated that acarbose and metformin were similarly efficacious at lowering blood glucose and blood pressure, as well as improving insulin sensitivity in Chinese patients newly diagnosed with type 2 diabetes mellitus. The purpose of this study was to identify the effects of acarbose and metformin therapy on albumin excretion in MARCH study.Baseline urine albumin/creatinine ratio (ACR) of 762 newly diagnosed, drug-naïve patients with type 2 diabetes mellitus was measured. Included patients were randomized to receive either acarbose or metformin and followed for 48 weeks. In addition to change in ACR, the estimated glomerular filtration rates (eGFR) and frequency of metabolic syndrome (MetS) were also assessed.Elevated ACR levels (≥30 mg/g) were present at baseline in 21.9% of all participants. A significant decline in urine ACR was observed in both the acarbose and metformin groups at week 24 and 48 (all P < 0.001). The proportion of patients with elevated ACRs was also reduced in both treatment groups at week 24 and 48 compared with baseline values (all P < 0.05). The change in urine ACR at week 48 was significantly greater in patients prescribed acarbose than in those prescribed metformin (P = 0.01). Both acarbose and metformin significantly decreased the frequency of MetS at week 24 and 48 (both P < 0.05). Neither treatment affected eGFR.In sum, both acarbose and metformin decreased urine ACR levels and reduced the frequency of elevated ACR and MetS in Chinese patients with newly diagnosed type 2 diabetes mellitus without affecting eGFR. After 48 weeks' intervention, acarbose therapy resulted in a greater reduction in urine ACR compared with metformin.

Effect of Metformin on Fibroblast Growth Factor-21 Levels in Patients with Newly Diagnosed Type 2 Diabetes.

BACKGROUND: Fibroblast growth factor (FGF)-21 is an important regulator of glucose metabolism. In the present study, we investigated whether plasma levels of FGF-21 changed in patients with newly diagnosed type 2 diabetes mellitus (T2DM) and assessed the effects of metformin treatment on plasma FGF-21 levels. MATERIALS AND METHODS: The plasma FGF-21 levels and the metabolic parameters of 226 patients with newly diagnosed T2DM and 100 sex- and age-matched normal glycemic tolerant (NGT) controls were measured. Seventy-four patients among of the 226 patients with T2DM were treated with metformin throughout the 12-week study period. The fasting plasma FGF-21 and high-sensitivity C-reactive protein (hs-CRP) levels were measured using enzyme-linked immunosorbent assay kits. RESULTS: The patients with T2DM had significantly higher fasting plasma FGF-21 levels (302.2 pg/mL [range, 201.3-454.4 pg/mL] vs. 104.5 pg/mL [range, 71.6-185.6 pg/mL]; P < 0.00) and hs-CRP levels (2.63 ± 2.81 mg/L vs. 1.58 ± 2.16 mg/L; P < 0.00) than the NGT subjects. The fasting plasma hs-CRP and FGF-21 levels were significantly decreased in the T2DM group after metformin treatment compared with pretreatment (respectively, 2.56 ± 1.75 mg/L vs. 3.28 ± 1.89 mg/L [P < 0.05] and 232.6 pg/mL [range, 154.3-307.8 pg/mL] vs. 313.9 pg/mL [range, 227.7-474.2 pg/mL] [P < 0.01]). CONCLUSIONS: In patients with T2DM, the plasma FGF-21 levels are increased but are significantly decreased after metformin treatment. Metformin may play a role in reducing the FGF-21 levels in patients with T2DM, likely through the amelioration of glucose-lipid metabolism and inflammation.

PPAR-α Agonist Fenofibrate Decreased Serum Irisin Levels in Type 2 Diabetes Patients with Hypertriglyceridemia.

Irisin is related to insulin resistance and metabolic disorders. The physiologic effects of irisin are partially mediated through peroxisome proliferator-activated receptor-α (PPAR-α). We investigated the effect of fenofibrate, a PPAR-α agonist, on serum irisin in type 2 diabetes patients with hypertriglyceridemia. This study evaluated cross-sectional and interventional studies of 25 type 2 diabetes patients with hypertriglyceridemia (group A) and 40 controls (group B). Group A was treated with fenofibrate (200 mg/day) for 8 weeks. Serum irisin and clinical characteristics were examined. Serum irisin was significantly higher in group A compared with group B (45.15 ± 10.48 versus 35.38 ± 9.97 ng/ml, P < 0.001) and correlated with body mass index (r = 0.314, P = 0.011), fasting blood glucose (r = 0.399, P = 0.001), total cholesterol (r = 0.256, P = 0.040), and high-density lipoprotein cholesterol (r = 0.247, P = 0.047). In multiple regression analysis after controlling for confounders, only fasting blood glucose (ß = 5.615, P < 0.001) and high-density lipoprotein cholesterol (ß = 19.483, P < 0.001) were independently related to serum irisin. After 8 weeks of fenofibrate treatment, serum irisin significantly decreased in group A compared with baseline (45.15 ± 10.48 versus 38.74 ± 12.54 ng/ml, P = 0.011). Conclusively, fenofibrate decreased serum irisin in type 2 diabetes patients with hypertriglyceridemia, indicating that PPAR-α agonists may protect against metabolic disorders by improving irisin resistance.

Resveratrol prevents hepatic steatosis and endoplasmic reticulum stress and regulates the expression of genes involved in lipid metabolism, insulin resistance, and inflammation in rats.

Previous research demonstrated that resveratrol possesses promising properties for preventing obesity. Endoplasmic reticulum (ER) stress was proposed to be involved in the pathophysiology of both obesity and hepatic steatosis. In the current study, we hypothesized that resveratrol could protect against high-fat diet (HFD)-induced hepatic steatosis and ER stress and regulate the expression of genes related to hepatic steatosis. Rats were fed either a control diet or a HFD for 12 weeks. After 4 weeks, HFD-fed rats were treated with either resveratrol or vehicle for 8 weeks. Body weight, serum metabolic parameters, hepatic histopathology, and hepatic ER stress markers were evaluated. Moreover, an RT2 Profiler Fatty Liver PCR Array was performed to investigate the mRNA expressions of 84 genes related to hepatic steatosis. Our work showed that resveratrol prevented dyslipidemia and hepatic steatosis induced by HFD. Resveratrol significantly decreased activating transcription factor 4, C/EBP-homologous protein and immunoglobulin binding protein levels, which were elevated by the HFD. Resveratrol also decreased PKR-like ER kinase phosphorylation, although it was not affected by the HFD. Furthermore, resveratrol increased the expression of peroxisome proliferator-activated receptor δ, while decreasing the expression of ATP citrate lyase, suppressor of cytokine signaling-3, and interleukin-1ß. Our data suggest that resveratrol can prevent hepatic ER stress and regulate the expression of peroxisome proliferator-activated receptor δ, ATP citrate lyase, suppressor of cytokine signaling-3, tumor necrosis factor α, and interleukin-1ß in diet-induced obese rats, and these effects likely contribute to resveratrol's protective function against excessive accumulation of fat in the liver.

Electrocardiographic profile of adenosine pharmacological stress testing.

Adenosine stress testing in conjunction with radionuclide myocardial perfusion imaging has become a common approach for the detection of coronary artery diseases in patients who are unable to perform adequate levels of exercise. However, specific electrocardiographic alterations during the test have been rarely described. Using a Chinese population, the aim of the present study was to provide a detailed electrocardiographic profile of adenosine stress testing. The study population included 1,168 consecutive outpatients who had undergone adenosine-induced stress myocardial perfusion imaging. Electrocardiographic data during and immediately following the adenosine infusion were collected, and the corresponding myocardial perfusion images were assessed. During adenosine infusion, 174 transient and 47 persistent arrhythmic events occurred in 110 patients (9.42%). Furthermore, frequent premature atrial contractions occurred in 65 individuals and frequent premature ventricular contractions were observed in 73 individuals. Atrioventricular block (AVB) occurred in 75 patients [first degree (I°) AVB, 16; second degree (II°) AVB, 58; third degree AVB, 1), while sinoatrial block occurred in eight patients. ST depression emerged in 69 patients. Patients with a baseline I° AVB had an increased risk of a II° AVB, and patients exhibiting baseline ST depression were more likely to have a further depressed ST segment during the stress test (odds ratio, 28.68 and 5.01, respectively; both P<0.001). Following adenosine infusion, 10 patients (0.86%) exhibited newly occurred arrhythmic events. However, no patient presented with acute myocardial infarction or sudden mortality. In conclusion, the results demonstrated that adenosine infusion was a safe method, despite the relatively high incidence of arrhythmic events. The majority of arrhythmias that occurred during infusion were transient, were reversible with the termination of infusion and did not indicate abnormal perfusion results.

Resveratrol increases nephrin and podocin expression and alleviates renal damage in rats fed a high-fat diet.

Resveratrol is well known for its anti-inflammation and anti-oxidant properties, and has been shown to be effective in alleviating the development of obesity. The purpose of this investigation was to analyze the effect of resveratrol on renal damage in obese rats induced by a high-fat diet (HFD) and its possible mechanisms. Male Sprague-Dawley rats were divided into three groups: control, HFD, and HFD plus resveratrol (treated with 100 mg/kg/day resveratrol). Body weight, serum and urine metabolic parameters, and kidney histology were measured. Meanwhile, the activities of nuclear factor-κB (NF-κB) and superoxide dismutase (SOD), the content of malondialdehyde (MDA), and the protein levels of tumor necrosis factor (TNF-α), monocyte chemotactic protein-1 (MCP-1), nephrin and podocin in kidney were detected. Our work showed that resveratrol alleviated dyslipidemia and renal damage induced by HFD, decreased MDA level and increased SOD activity. Furthermore, the elevated NF-κB activity, increased TNF-α and MCP-1 levels, and reduced expressions of nephrin and podocin induced by HFD were significantly reversed by resveratrol. These results suggest resveratrol could ameliorate renal injury in rats fed a HFD, and the mechanisms are associated with suppressing oxidative stress and NF-κB signaling pathway that in turn up-regulate nephrin and podocin protein expression.

Exenatide improves type 2 diabetes concomitant with non-alcoholic fatty liver disease / Exenatide melhora o diabetes tipo 2 de ocorrência concomitante com doença hepática gordurosa não alcoólica

OBJECTIVE: To investigate the effects of exenatide on blood glucose, body weight and hepatic enzymes in patients with type 2 diabetes mellitus (T2DM) and concomitant non-alcoholic fatty liver disease (NAFLD). SUBJECTS AND METHODS: One hundred and seventeen patients with T2DM and NAFLD were randomly divided into exenatide group and metformin group. Patients were treated with exenatide and metformin, respectively, for 12 weeks. RESULTS: After 12 weeks of treatment, body weight, body mass index (BMI), waist-to-hip ratio, HbA1c, FPG, 2-h PPG, ALT, AST, γ-GT, and hs-CRP were significantly reduced, and the AST/ALT ratio and adiponectin were markedly increased in both groups. BMI, waist-to-hip ratio, 2-h PPG, ALT, AST, γ-GT, and hs-CRP were markedly lower, and AST/ALT ratio and adiponectin in the exenatide group were dramatically higher than in the metformin group. CONCLUSION: Compared with metformin, exenatide is better to control blood glucose, reduces body weight and improves hepatic enzymes, attenuating NAFLD in patients with T2DM concomitant with NAFLD.

OBJETIVO: Investigar os efeitos do exenatide sobre a glicose sérica, peso corporal e enzimas hepáticas em pacientes com diabetes melito tipo 2 (T2DM) e doença hepática gordurosa não alcoólica (DHGNA). SUJEITOS E MÉTODOS: Um total de 117 pacientes com T2DM e DHGNA foi aleatoriamente separado em dois grupos, um tratado com exenatide e um tratado com metformina. Os pacientes foram tratados por 12 semanas. RESULTADOS: Após 12 semanas de tratamento, o peso corporal, índice de massa corporal (IMC), relação cintura-quadril, HbA1c, FPG, glicose pós-prandial, ALT, AST, γ-GT e proteína C-reativa foram significativamente reduzidos, e a relação AST/ALT e a adiponectina aumentaram marcadamente nos dois grupos. O IMC, relação cintura-quadril, glicose pós-prandial, ALT, AST, γ-GT e proteína C-reativa foram marcadamente menores, e a relação AST/ALT e a adiponectina foram dramaticamente mais altas no grupo tratado com exenatide do que no grupo tratado com metformina. CONCLUSÃO: Comparado com a metformina, o exenatide controla melhor a glicose sérica, reduz o peso corporal e melhora as enzimas hepáticas, atenuando a DHGNA em pacientes com T2DM de ocorrência concomitante com a DHGNA.

Influence of islet function on typing and prognosis of new-onset diabetes after intensive insulin therapy.

BACKGROUND: It is difficult in clinical practice to differentiate patients with newly diagnosed diabetes and ketosis. The aim of this study was to investigate the effect of intensive insulin therapy on islet function in patients with new-onset diabetes and concomitant ketosis, and to determine the value of alternation in islet function in the typing of diabetes. MATERIAL/METHODS: A total of 206 inpatients with new-onset diabetes and ketosis were recruited after intensive insulin therapy and followed for 36 months. Patients were divided into type 1 diabetes group (Group A) and type 2 diabetes group (Group B). Islet function was compared between the 2 groups before and after intensive insulin therapy, and the influence of islet function on the typing of diabetes and the selection of therapeutic strategies is discussed. RESULTS: In group A, the AUCI, AUCC, HOMA-â cell and HOMA-IR were significantly lower than those in Group B before and after intensive insulin therapy. The sensitivity and accuracy of antibody test were at a low level in Group A. An insulin release test was done after intensive insulin therapy. Results showed that the peaks of insulin and C peptide appeared at 0.5-1 h after glucose administration in Group A, which was earlier than that before therapy, but the maximal levels were no more than 2 times those of baseline levels. In Group B, the peaks appeared at 2 h, and the maximal levels were about 10 times those of baseline levels. CONCLUSIONS: Poor islet function, incomplete recovery of islet function after intensive insulin therapy, and a short "honeymoon" period are characteristics of type 1 diabetes. Detection of diabetes-related antibodies is not reliable.

Exenatide improves type 2 diabetes concomitant with non-alcoholic fatty liver disease.

OBJECTIVE: To investigate the effects of exenatide on blood glucose, body weight and hepatic enzymes in patients with type 2 diabetes mellitus (T2DM) and concomitant non-alcoholic fatty liver disease (NAFLD). SUBJECTS AND METHODS: One hundred and seventeen patients with T2DM and NAFLD were randomly divided into exenatide group and metformin group. Patients were treated with exenatide and metformin, respectively, for 12 weeks. RESULTS: After 12 weeks of treatment, body weight, body mass index (BMI), waist-to-hip ratio, HbA1c, FPG, 2-h PPG, ALT, AST, γ-GT, and hs-CRP were significantly reduced, and the AST/ALT ratio and adiponectin were markedly increased in both groups. BMI, waist-to-hip ratio, 2-h PPG, ALT, AST, γ-GT, and hs-CRP were markedly lower, and AST/ALT ratio and adiponectin in the exenatide group were dramatically higher than in the metformin group. CONCLUSION: Compared with metformin, exenatide is better to control blood glucose, reduces body weight and improves hepatic enzymes, attenuating NAFLD in patients with T2DM concomitant with NAFLD.

[The effect of enteral nutritional suspension (diabetes) (TPF-DM) on blood glucose, serum insulin and lipids in patients with type 2 diabetes].

OBJECTIVE: To investigate the effect of a new enteral nutrition suspension (diabetes) (TPF-DM) (Dixson 0.75 kcal/ml) (1 kcal = 4.184 kJ) on blood glucose, serum insulin and lipids as compared with a standard formula (Nutrition MF 0.75 kcal/ml) in patients with type 2 diabetes. METHODS: A randomized, controlled, paralleled and single center trial was carried out. A total of 76 patients with type 2 diabetes without using insulin and obvious complications were randomized into a study group and a control group. 36 patients in the study group and 35 in the control group completed the trial. The observation lasted 6 days. All calories came from enteral nutrition. At baseline all the patients had standard mixed meal (bread 50 g, egg 50 g, milk 250 ml, total calorie 400 kcal) test and at the end of the trial a enteral nutrient meal (enteral nutrient 400 ml, total calorie 300 kcal) test. Blood samples were taken before the meal and 30, 60, 120 and 180 minutes after the meal to test plasma glucose, serum insulin, serum lipids and some safety parameters. The area under curve (AUC) for plasma glucose, serum insulin, serum lipids was calculated. RESULTS: Compared with the mixed meal test, the AUC of plasma glucose and serum insulin during both Dixson 0.75 kcal/ml test and standard formula (Nutrition MF 0.75 kcal/ml) test were significantly lower (P < 0.01). The change at baseline in the study group was more than that in the control group [the change of AUC for plasma glucose (-6.42 +/- 8.62) h x mmol x L(-1) vs (-1.87 +/- 5.30) h x mmol x L(-1), P < 0.01; that of AUC for serum insulin (-36.94 +/- 49.77) h x mIU x L(-1) vs (-18.20 +/- 32.62) h x mIU x L(-1), P < 0.05]. Both the enteral nutrition formula can reduce insulin resistance (calculated by HOMA-IR), but there was no difference between them. There was no significant effect on total cholesterol, high density lipoprotein and low density lipoprotein. AUC of serum triglycerides was lower during the tests with both enteral nutrients than that during mixed meal test, but there was no significant difference between the two groups. There was no safety concern about the enteral nutrition. CONCLUSION: Enteral nutrition suspension (diabetes) (TPF-DM) (Dixson 0.75 kcal/ml) is an effective and safe enteral nutrient to be used in patients with type 2 diabetes.