Current Issue : October - December Volume : 2015 Issue Number : 4 Articles : 8 Articles
Background: Low levels of vitamin D have been related to increased mortality and morbidity in several non-diabetic\nstudies. We aimed to prospectively study relationships between serum 25-OH vitamin D3 (vitamin D) and of serum\nparathyroid hormone (PTH) to total mortality in type 2 diabetes. We also aimed to compare the levels of these potential\nrisk-factors in patients with and without diabetes.\nMethods: The main study design was prospective and observational. We used baseline data from 472 men and\n245 women who participated in the ââ?¬Å?Cardiovascular Risk factors in Patients with Diabetesââ?¬â?a Prospective study in\nPrimary careââ?¬Â study. Patients were 55ââ?¬â??66 years old at recruitment, and an age-matched non-diabetic sample of\n129 individuals constituted controls for the baseline data. Carotid-femoral pulse-wave velocity (PWV) was measured\nwith applanation-tonometry and carotid intima-media thickness (IMT) with ultrasound. Patients with diabetes were\nfollowed for all-cause mortality using the national Swedish Cause of Death Registry.\nResults: Levels of vitamin D were lower in patients with diabetes than in controls, also after correction for age and\nobesity, while PTH levels did not differ. Nine women and 24 men died during 6 years of median follow up of the final\ncohort (n = 698). Vitamin D levels were negatively related to all-cause mortality in men independently of age, PTH,\nHbA1c, waist circumference, 24-h systolic ambulatory-blood pressure (ABP) and serum-apoB (p = 0.049). This finding\nwas also statistically significant when PWV and IMT were added to the analyses (p = 0.028) and was not\naffected statistically when medications were also included in the regression-analysis (p = 0.01). In the women with type\n2 diabetes, levels of PTH were positively related with all-cause mortality in the corresponding calculations\n(p = 0.016 without PWV and IMT, p = 0.006 with PWV and IMT, p = 0.045 when also adding medications to the\nanalysis), while levels of vitamin D was without statistical significance (p >0.9).\nConclusions: Serum vitamin D in men and serum PTH in women give prognostic information in terms of total-mortality\nthat are independent of regular risk factors in addition to levels of ABP, IMT and PWV....
Background: Glucose fluctuation has been recognized as a residual risk apart from dyslipidemia for the development\nof coronary artery disease (CAD). This study aimed to investigate the association between glucose fluctuation and\ncoronary plaque morphology in CAD patients.\nMethods: This prospective study enrolled 72 consecutive CAD patients receiving adequate lipid-lowering therapy.\nThey were divided into 3 tertiles according to the mean amplitude of glycemic excursions (MAGE), which represents\nglucose fluctuation, measured by continuous glucose monitoring (tertile 1; <49.1, tertile 2; 49.1 ~ 85.3, tertile 3; >85.3).\nMorphological feature of plaques were evaluated by optical coherence tomography. Lipid index (LI) (mean lipid\narc Ã?â?? length), fibrous cap thickness (FCT), and the prevalence of thin-cap fibroatheroma (TCFA) were assessed in\nboth culprit and non-culprit lesions.\nResults: In total, 166 lesions were evaluated. LI was stepwisely increased according to the tertile of MAGE (1958 Ã?± 974\n[tertile 1] vs. 2653 Ã?± 1400 [tertile 2] vs. 4362 Ã?± 1858 [tertile 3], p <0.001), whereas FCT was the thinnest in the tertile 3\n(157.3 Ã?± 73.0 ?m vs. 104.0 Ã?± 64.1 ?m vs. 83.1 Ã?± 34.7 ?m, p <0.001, respectively). The tertile 3 had the highest prevalence\nof TCFA. Multiple linear regression analysis showed that MAGE had the strongest effect on LI and FCT (standardized\ncoefficient ? = 0.527 and ?0.392, respectively, both P <0.001). Multiple logistic analysis identified MAGE as the only\nindependent predictor of the presence of TCFA (odds ratio 1.034; P <0.001).\nConclusions: Glucose fluctuation and hypoglycemia may impact the formation of lipid-rich plaques and thinning\nof fibrous cap in CAD patients with lipid-lowering therapy...
BACKGROUND/OBJECTIVES: There is controversy regarding the existence of a body mass index (BMI) mortality paradox in\ndiabetes, whereby the optimal BMI category is higher than it is in non-diabetic persons. To explore possible pathways to a mortality\nparadox, we examined the relationship of BMI with physical and mental health status in diabetic and non-diabetic persons.\nSUBJECTS/METHODS: We examined adjusted SF-12 Physical and Mental Component Summary (PCS-12 and MCS-12) scores by BMI\n(kgm? 2) category (underweight, o20; normal weight, 20 to o25; overweight, 25 to o30; obese, 30 to o35; severely obese ? 35)\nin adult diabetic and non-diabetic respondents to the 2000ââ?¬â??2011 United States national Medical Expenditure Panel Surveys\n(N = 119 161). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, comorbidity, urbanicity,\ngeographic region and survey year.\nRESULTS: In non-diabetic persons the adjusted mean PCS-12 score was highest (that is, most optimal) in the normal-weight\ncategory, whereas for diabetic persons the optimal adjusted mean PCS-12 score was in the overweight category (adjusted\ndifference between non-diabetic and diabetic persons in the difference in PCS-12 means for overweight versus normal-weight\ncategory = 0.8 points, 95% confidence interval; CI 0.1, 1.6; P = 0.03). This paradoxical pattern was not evident for the MCS-12, and the\nadjusted difference between non-diabetic and diabetic persons in the difference in MCS-12 means for overweight versus obese\npersons was not significant (?0.3 points, 95% CI ? 0.9, 0.4; P = 0.43). The findings were not significantly moderated by smoking\nstatus, cancer diagnosis or time period.\nCONCLUSIONS: The optimal BMI category for physical health status (but not mental health status) was higher among diabetic than\nnon-diabetic persons. The findings are consistent with a BMI physical health status paradox in diabetes and, in turn, a mortality\nparadox....
Background: Left ventricular (LV) diastolic dysfunction is frequently observed in patients with type 2 diabetes.\nDipeptidyl peptidase-4 inhibitor (DPP-4i) attenuates postprandial hyperglycemia (PPH) and may have cardio-protective\neffects. It remains unclear whether DPP-4i improves LV diastolic function in patients with type 2 diabetes, and, if so, it is\nattributable to the attenuation of PPH or to a direct cardiac effect of DPP-4i. We compared the effects of the DPP-4i,\nsitagliptin, and the alpha-glucosidase inhibitor, voglibose, on LV diastolic function in patients with type 2 diabetes.\nMethods: We conducted a prospective, randomized, open-label, multicenter study of 100 diabetic patients with LV\ndiastolic dysfunction. Patients received sitagliptin (50 mg/day) or voglibose (0.6 mg/day). The primary endpoints were\nchanges in the eâ�� velocity and E/eâ�� ratio from baseline to 24 weeks later. The secondary efficacy measures included\nHbA1c, GLP-1, lipid profiles, oxidative stress markers and inflammatory markers.\nResults: The study was completed with 40 patients in the sitagliptin group and 40 patients in the voglibose group.\nThere were no significant changes in the eâ�� velocity and E/eâ�� ratio from baseline to 24 weeks later in both groups.\nHowever, analysis of covariance demonstrated that pioglitazone use is an independent factor associated with changes\nin the eâ�� and E/eâ�� ratio. Among patients not using pioglitazone, eâ�� increased and the E/eâ�� ratio decreased in both the\nsitagliptin and voglibose groups. GLP-1 level increased from baseline to 24 weeks later only in the sitagliptin group\n(4.8 �± 4.7 vs. 7.3 �± 5.5 pmol/L, p < 0.05). The reductions in HbA1c and body weight were significantly greater in the\nsitagliptin group than in the voglibose group (?0.7 �± 0.6 % vs. ?0.3 �± 0.4, p < 0.005; ?1.3 �± 3.2 kg vs. 0.4 �± 2.8 kg,\np < 0.05, respectively). There were no changes in lipid profiles and inflammatory markers in both groups.\nConclusions: Our trial showed that sitagliptin reduces HbA1c levels more greatly than voglibose does, but that neither\nwas associated with improvement in the echocardiographic parameters of LV diastolic function in patients with\ndiabetes....
OBJECTIVES: Low glycaemic index (GI) foods are recommended to improve glycaemic control in diabetes; however, Health Canada\nconsiders that GI food labeling would be misleading and unhelpful, in part, because selected studies suggest that GI values are\ninaccurate due to an effect of ethnicity. Therefore, we conducted a systematic review and meta-analysis to compare the GI of foods\nwhen measured in Caucasians versus non-Caucasians.\nMETHODS: We searched MEDLINE, EMBASE and Cochrane databases for relevant articles. GI differences were aggregated using the\ngeneric inverse variance method (random effects model) and expressed as mean difference (MD) with 95% confidence intervals\n(95% CI). Study quality was assessed based on how well studies complied with official international GI methodology.\nRESULTS: Review of 1288 trials revealed eight eligible studies, including 28 comparisons of GI among 585 non-Caucasians and 971\nCaucasians. Overall, there was borderline significant evidence of higher GI in non-Caucasians than Caucasians (MD, 3.3 (95% CI,\n? 0.1, 6.8); P = 0.06) with significant heterogeneity (I2, 46%; P = 0.005). The GI of eight types of rice was higher in non-Caucasians\nthan Caucasians (MD, 9.5 (95% CI, 3.7, 23.1); P = 0.001), but there was no significant difference for the other 20 foods (MD, 1.0 (95%\nCI, ? 2.5, 4.6); P = 0.57). MD was significantly greater in the four low-quality studies (nine comparisons) than the four high-quality\nstudies (19 comparisons; 7.8 vs 0.7, P = 0.047).\nCONCLUSIONS: With the possible exception of rice, existing evidence suggests that GI values do not differ when measured in\nCaucasians versus non-Caucasians. To confirm these findings high-quality studies using a wide range of foods are required....
BACKGROUND AND OBJECTIVES: Lean Asian Indians are less insulin sensitive compared with Chinese and Malays, but the\npancreatic beta-cell function among these ethnic groups has yet to be studied in depth. We aimed to study beta-cell function in\nrelation to insulin sensitivity among individuals of Chinese, Malay and Asian-Indian ethnicity living in Singapore.\nSUBJECTS AND METHODS: This is a sub-group analysis of 59 normoglycemic lean (body mass index (BMI) o23 kgm?2) adult\nmales (14 Chinese, 21 Malays and 24 Asian Indians) from the Singapore Adults Metabolism Study. Insulin sensitivity was determined\nusing fasting state indices (homeostatic model assessmentââ?¬â?insulin resistance), the euglycemic-hyperinsulinemic clamp (ISI-clamp)\nand a liquid mixed-meal tolerance test (LMMTT) (Matsuda insulin sensitivity index (ISI-Mat)). Beta-cell function was assessed using\nfasting state indices (homeostatic model assessmentââ?¬â?beta-cell function) and from the LMMTT (insulinogenic index and insulin\nsecretion index). The oral disposition index (DI), a measure of beta-cell function relative to insulin sensitivity during the LMMTT, was\ncalculated as a product of ISI-Mat and insulin secretion index.\nRESULTS: Asian Indians had higher waist circumference and percent body fat than Chinese and Malays despite similar BMI. Overall,\nAsian Indians were the least insulin sensitive whereas the Chinese were most insulin sensitive. Asian Indians had higher beta-cell\nfunction compared with Chinese or Malays but these were not statistically different. Malays had the highest incremental area under\nthe curve for glucose during LMMTT compared with Asian Indians and Chinese. However, there were no significant ethnic differences\nin the incremental insulin area under the curve. The oral DI was the lowest in Malays, followed by Asian Indians and Chinese.\nCONCLUSION: Among lean Asians, Chinese are the most insulin sensitive whereas Asian Indians are the least insulin sensitive.\nHowever, Malays demonstrate higher postprandial glucose excursion with lower beta-cell response compare with Chinese or Asian\nIndians. The paths leading to type 2 diabetes mellitus might differ between these Asian ethnic groups....
OBJECTIVES: Extra virgin olive oil (EVOO) is a key component of the Mediterranean diet and seems to account for the protective\neffect against cardiovascular disease. However, the underlying mechanism is still elusive.\nDESIGN: We tested the effect of EVOO, added to Mediterranean-type meal, on post-prandial glycemic and lipid profile.\nSUBJECTS: Post-prandial glycemic and lipid profile were investigated in 25 healthy subjects who were randomly allocated in a\ncross-over design to a Mediterranean-type meal added with or without 10 g EVOO (first study), or Mediterranean-type meal with\nEVOO (10 g) or corn oil (10 g; second study). Glycemic profile, which included glucose, insulin, dipeptidyl-peptidase-4 (DPP-4)\nprotein and activity, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), and lipid profile,\nwhich included, low-density lipoprotein (LDL) cholesterol (LDL-C), oxidized LDL (ox-LDL), triglycerides and high-density lipoprotein\n(HDL) cholesterol (HDL-C), were analyzed before and 2 h after the meal.\nRESULTS: In the first study, 2 h after meal, subjects who assumed a meal with EVOO had significantly lower blood glucose\n(Po0.001), DPP-4 protein (Po0.001) and activity (Po0.001), LDL-C (Po0.001) and ox-LDL (Po0.001) and higher insulin (Po0.05),\nGLP-1 (Po0.001) and GIP (Po0.05) compared with those without EVOO. The second study showed that compared with corn oil,\nEVOO improved both glycemic and lipid profile. Thus, a significantly smaller increase of glucose (Po0.05), DPP4 protein (Po0.001)\nand activity (Po0.05) and higher increase of insulin (Po0.001) and GLP-1 (Po0.001) were observed. Furthermore, compared with\ncorn oil, EVOO showed a significantly less increase of LDL-C (Po0.05) and ox-LDL (Po0.001).\nCONCLUSIONS: We report for the first time that EVOO improves post-prandial glucose and LDL-C, an effect that may account for\nthe antiatherosclerotic effect of the Mediterranean diet....
Background: Patients with type 2 diabetes mellitus (DM) display a predisposition for vascular disease. Platelets\ntaken from vasculopathic diabetic patients, show enhanced stimuli-induced activation and aggregation responses.\nAspirin remains the cornerstone antiplatelet agent for secondary prevention of vascular complications among\ndiabetic patients, yet evidence of its efficacy and safety in primary prevention are conflicting. Our aim was to assess\nwhether high risk diabetic patients, without previous ischemic events, have abnormal platelet functionality profiles.\nMethods: The study included 82 diabetic patients and 86 matched non-diabetic patients without prior ischemic\nevents nor treatment with anti-platelet medications. Blood samples were analyzed for platelet markers of activation,\nturnover and leukocyte-platelet interactions.\nResults: Our final analysis included 122 males (74 %), with a mean age of 61 years. Mean platelet volume (MPV)\nwas similar between the diabetic patients and controls (9.2 fL for both). Following activation, PAC-1 binding and\nP-selectin expression were found comparable between the diabetic patients and controls (83 % versus 81 % and\n76 % versus 74 %, respectively). Leukocyte-platelet aggregates (LPAs) were similar between the diabetic patients\nand controls (18 % versus 17 %, respectively). Neutrophil-platelet aggregates (NPAs) and monocyte-platelet\naggregates (MPAs) were also found similar in the diabetic patients and controls. Elevated fasting plasma glucose\nwas associated with increased LPAs rates.\nConclusions: High risk type-2 diabetes mellitus patients, without prior ischemic events, have normal blood platelet\nfunctionality profiles....
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