DOCSLIB.ORG

Relationships of Surrogate Indexes of Insulin Resistance with Insulin Sensitivity Assessed by Euglycemic Hyperinsulinemic Clamp and Subclinical Vascular Damage

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Relationships of Surrogate Indexes of Insulin Resistance with Insulin Sensitivity Assessed by Euglycemic Hyperinsulinemic Clamp and Subclinical Vascular Damage Metabolism Open access Original research BMJ Open Diab Res Care: first published as 10.1136/bmjdrc-2019-000911 on 13 November 2019. Downloaded from Relationships of surrogate indexes of insulin resistance with insulin sensitivity assessed by euglycemic hyperinsulinemic clamp and subclinical vascular damage Teresa Vanessa Fiorentino ,1 Maria Adelaide Marini,2 Elena Succurro,1 Francesco Andreozzi,1 Giorgio Sesti3 To cite: Fiorentino TV, ABSTRACT Marini MA, Succurro E, et al. Introduction Insulin resistance plays a crucial role in Significance of this study Relationships of surrogate the pathogenesis of type 2 diabetes and cardiovascular indexes of insulin resistance disease. The triglyceride to high- density lipoprotein What is already known about this subject? with insulin sensitivity cholesterol (TG/HDL-C) ratio, visceral adiposity index ► The triglyceride to high- density lipoprotein choles- assessed by euglycemic terol (TG/HDL- C) ratio, visceral adiposity index (VAI), hyperinsulinemic clamp and (VAI), lipid accumulation product (LAP) and triglycerides × fasting glucose (TyG) index are surrogate measures lipid accumulation product (LAP) and triglycerides × subclinical vascular damage. fasting glucose (TyG) index have been developed as of insulin sensitivity based on anthropometric and/or BMJ Open Diab Res Care surrogate measures of insulin resistance based on 2019;7:e000911. doi:10.1136/ biochemical parameters routinely collected in clinical bmjdrc-2019-000911 practice. Herein, we compared the relationships of these anthropometric and/or biochemical parameters rou- four surrogate indexes with insulin sensitivity assessed tinely collected in clinical practice. by the gold standard euglycemic hyperinsulinemic clamp What are the new findings? ► Additional material is technique, and subclinical vascular damage. ► Among the four surrogate indexes of insulin resis- copyright. published online only. To view Research design and methods 631 subjects with please visit the journal online tance, LAP index correlates better with insulin sen- different degrees of glucose tolerance underwent (http:// dx. doi. org/ 10. 1136/ sitivity assessed by the gold standard euglycemic euglycemic hyperinsulinemic clamp. The surrogate TG/ bmjdrc- 2019- 000911). hyperinsulinemic clamp technique. HDL-C ratio, VAI, LAP and TyG indexes were computed. ► LAP index was the only surrogate index showing Pulse pressure and carotid intima-media thickness (IMT) significant association with the insulin sensitivity in Received 14 September 2019 were measured as indicators of subclinical vascular individuals with impaired glucose tolerance or type Revised 8 October 2019 damage. 2 diabetes. Accepted 16 October 2019 Results All the four surrogate indexes showed a The ability of LAP index to identify subjects with in- significant correlation with insulin- stimulated glucose ► sulin resistance is higher than TG/HDL- C ratio, VAI disposal in the whole study population. However, only and TyG indexes. LAP index had a significant association with insulin sensitivity across the different glucose tolerance ► All the four indexes have a similar ability to de- http://drc.bmj.com/ groups. LAP index showed the highest area under tect individuals with subclinical atherosclerosis. the receiver operating characteristic curve (0.728) Conversely, LAP index had the greatest ability to rec- to detect individuals with insulin resistance defined ognize individuals with increased vascular stiffness. © Author(s) (or their employer(s)) 2019. Re- use as the bottom quartile of insulin- stimulated glucose How might these results change the focus of permitted under CC BY-NC. No disposal, followed by TG/HDL- C ratio (0.693), TyG index research or clinical practice? commercial re- (0.688) and VAI (0.688). A significant association was use. See rights ► Among the four surrogate measures of insulin re- on September 25, 2021 by guest. Protected and permissions. Published found between the four indexes of insulin sensitivity sistance based on anthropometric and biochemical by BMJ. and pulse pressure and IMT. All the four indexes have parameters, LAP index is the best discriminator of 1 a similar ability to detect individuals with vascular Department of Medical and insulin resistance and subclinical vascular damage. Surgical Sciences, Magna atherosclerosis defined by IMT>0.9 mm. Conversely, Assessment of LAP index in clinical practice should Graecia University of Catanzaro, LAP index had the greatest ability to recognize ► be preferred to TG/HDL- C ratio, VAI and TyG indexes Catanzaro, Italy individuals with increased vascular stiffness defined by 2 for a better cardiometabolic risk stratification. Department of Systems pulse pressure ≥60 mm Hg. Medicine, University of Rome Conclusion Among the surrogate TG/HDL-C ratio, VAI, LAP Tor Vergata, Roma, Lazio, Italy and TyG indexes of insulin sensitivity, LAP index showed 3Department of Clinical and a significant association with insulin-stimula ted glucose Molecular Medicine, University INTRODUCTION disposal across the different glucose tolerance categories of Rome La Sapienza, Roma, Insulin resistance is a characteristic trait of both Lazio, Italy and the highest ability to detect insulin resistance and 1–3 4–6 subclinical vascular damage. pre- diabetes and metabolic syndrome. Correspondence to Insulin resistance is considered central to the 7 8 Dr Teresa Vanessa Fiorentino; pathophysiology of type 2 diabetes, and vanessa. fiorentino@ unicz. it predicts the development of cardiovascular BMJ Open Diab Res Care 2019;7:e000911. doi:10.1136/bmjdrc-2019-000911 1 Metabolism BMJ Open Diab Res Care: first published as 10.1136/bmjdrc-2019-000911 on 13 November 2019. Downloaded from disease.9–11 Although insulin resistance is an important by bioelectrical impedance. Height was measured to the determinant of cardiometabolic diseases, a direct measure nearest 0.1 cm, while body weight was measured with a cali- of insulin sensitivity by the gold standard euglycemic hyper- brated electronic scale to the nearest 0.1 kg. Waist circum- insulinemic clamp technique12 is impractical for large-scale ference was measured at the umbilical level, at the midpoint epidemiological studies, due to the laborious, expensive, between the iliac crest and the rib cage. The BMI was and time- consuming procedure required. Therefore, many calculated as body weight in kilograms divided by height in surrogate indexes of insulin sensitivity have been proposed square meters (kg/m2). Blood pressure was measured after using anthropometric variables, fasting insulin and/or a 5 min rest at the right upper arm, in the sitting position, glucose levels or insulin and glucose levels during an oral with a sphygmomanometer for three times and the mean glucose tolerance test (OGTT).13–15 An ideal surrogate was used in the analyses. Pulse pressure was calculated as index of insulin sensitivity for use in large epidemiolog- the difference between systolic blood pressure and diastolic ical studies should be based on affordable anthropometric blood pressure. A value of pulse pressure ≥60 mm Hg was and/or laboratory measures routinely gathered in clinical used as index of increased vascular stiffness.32 A 75 g OGTT settings. Among these, the visceral adiposity index (VAI),16 was performed with basal and 2- hour postload sampling for and the lipid accumulation product (LAP), both based on plasma glucose assays. On the second day, after a 12- hour anthropometric and laboratory parameters17 have been fasting, participants underwent a euglycemic hyperinsu- developed and analyzed in relation to homeostatic model linemic clamp study, as previously described.33 Briefly, assessment of insulin resistance (HOMA- IR), but not to a priming dose of insulin was administrated during the the gold standard measure of insulin sensitivity assessed by early 10 min to acutely increase plasma insulin followed the euglycemic hyperinsulinemic clamp method.18–25 Addi- by continuous insulin infusion fixed at 40 mU/m2 × min. tionally, two other surrogate indexes of insulin sensitivity Blood glucose levels were maintained constant during the based on plasma triglyceride (TG) and high-density lipo- 2- hour clamp study by infusing 20% glucose at varying protein cholesterol (HDL- C) measurements, that is, the rates according to blood glucose measurements assessed triglycerides × fasting glucose (TyG) index and TG/HDL-C by a glucose analyzer at 5 min intervals. Glucose metabo- concentration ratio, have been suggested as surrogate esti- lized by the whole body (M) was calculated as the mean mates of insulin sensitivity, and validated in comparison rate of glucose infusion measured during the last 60 min of to the euglycemic hyperinsulinemic clamp method,26 the the clamp examination (steady state) and was expressed as copyright. steady- state plasma glucose (SSPG) concentration during milligrams per minute per kilogram fat- free mass (MFFM). the insulin suppression test27 or a 3-hour hyperglycemic Subjects were considered insulin resistant when they were 28 clamp test. Although these two lipid- based surrogate in the lower quartile of MFFM values of the study cohort. indexes have been studied in non- diabetic individuals, Carotid IMT was measured by ATL HDI 3000 ultrasound in subjects with impaired fasting glucose (IFG), and in system (Advanced Technology Laboratories, Bothell, WA) patients with type 2 diabetes,26–28 it is unknown whether equipped with a 5 MHz linear array transducer as previ- they might be useful in the identification
Load more

Recommended publications
  • Homeostasis Model Assessment Closely Mirrors the Glucose Clamp
    Emerging Treatments and T e c h n o l o g i e s ORIGINAL AR T I C L E Homeostasis Model Assessment Closely Mirrors the Glucose Clamp Technique in the Assessment of Insulin Se n s i t i v i t y Studies in subjects with various degrees of glucose tolerance and insulin se n s i t i v i t y ENZO BONORA, MD, PHD FRANCESCA SAGGIANI, MD sulin sensitivity (7). However, this method GIOVANNI TARGHER, MD MARINA B. ZENERE, MD is laborious, expensive, and theref o r e un- MARIA ALBERICHE, MD TIZIANO MONAUNI, MD suitable for large-scale or epidemiological RICCARDO C. BONADONNA, MD MICHELE MUGGEO, MD studies. Several alternative methods to evaluate insulin sensitivity have been pro- posed during the last two decades (8–13), but, although generally less complex and less troublesome than the glucose clamp OB J E C T I V E — To evaluate whether the homeostasis model assessment (HOMA) is a rel i - technique, none of them is as simple as is able surrogate measure of in vivo insulin sensitivity in humans. ne c e s s a r y in large-scale studies involving RESEARCH DESIGN AND METHODS — In the present study, we compared insulin hu n d r eds or thousands of subjects. sensitivity as assessed by a 4-h euglycemic ( 5 mmol/l) hyperinsulinemic ( 300 pmol/l) clamp Homeostasis model assessment (HOMA) with HOMA in 115 subjects with various degrees of glucose tolerance and insulin sensitivity. of insulin sensitivity was proposed about 10 years ago as a simple and inexpensive alter- RE S U LT S — We found a strong correlation between clamp-measured total glucose disposal native to more sophisticated techniques and HOMA-estimated insulin sensitivity (r = 0.820, P 0.0001), with no substantial dif- (14).
    [Show full text]
  • Surrogate Measures of Insulin Sensitivity Vs the Hyperinsulinaemic–Euglycaemic Clamp: a Meta-Analysis
    Diabetologia (2014) 57:1781–1788 DOI 10.1007/s00125-014-3285-x META-ANALYSIS Surrogate measures of insulin sensitivity vs the hyperinsulinaemic–euglycaemic clamp: a meta-analysis Julia Otten & Bo Ahrén & Tommy Olsson Received: 9 December 2013 /Accepted: 28 April 2014 /Published online: 3 June 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract Conclusions/interpretation The revised QUICKI fasting sur- Aims/hypothesis We aimed to identify which surrogate index rogate measure appears to be as good as the OGTT-based of insulin sensitivity has the strongest correlation with the Stumvoll MCR, OGIS, Matsuda, Stumvoll ISI and Gutt indi- reference measurement, the hyperinsulinaemic–euglycaemic ces for estimating insulin sensitivity. It can therefore be rec- clamp (HEC), to determine which surrogate measure should ommended as the most appropriate index for use in large-scale be recommended for use in large-scale studies. clinical studies. Methods A literature search (1979–2012) was conducted to retrieve all articles reporting bivariate correlations between the Keywords Glucose . Hyperinsulinaemic–euglycaemic HEC and surrogate measures of insulin sensitivity (in fasting clamp . Insulin . Insulin sensitivity . Meta-analysis . Surrogate samples or during the OGTT). We performed a random effects markers meta-analysis for each surrogate measure to integrate the correlation coefficients of the different studies. Abbreviations Results The OGTT-based surrogate measures with the stron- FIRI Fasting insulin resistance index gest pooled correlations (r) to the HEC were the Stumvoll G0 Fasting glucose metabolic clearance rate (Stumvoll MCR; r=0.70 [95% CI HEC Hyperinsulinaemic–euglycaemic clamp 0.61, 0.77], n=5), oral glucose insulin sensitivity (OGIS; HOMA-%S HOMA of insulin sensitivity r=0.70 [0.57, 0.80], n=6), the Matsuda index (r=0.67 [0.61, (computer generated) 0.73], n=19), the Stumvoll insulin sensitivity index (Stumvoll I0 Fasting insulin ISI; r=0.67 [0.60, 0.72], n=8) and the Gutt index (r=0.65 IGT Impaired glucose tolerance [0.60, 0.69], n=6).
    [Show full text]
  • Risk Factors for Feline Diabetes Mellitus
    Risk factors for feline diabetes mellitus Lars Slingerland 2008 1 Risk factors for feline diabetes mellitus Risicofactoren voor diabetes mellitus bij de kat (met een samenvatting in het Nederlands) Proefschrift ter verkrijging van de graad van doctor aan de Universiteit Utrecht op gezag van de rector magnificus, prof.dr. J.C.Stoof, ingevolge het besluit van het college van promoties in het openbaar te verdedigen op donderdag 7 februari 2008 des middags te 4.15 uur door Lars Ingmar Slingerland geboren op 30 mei 1974, te Willemstad (Curaçao). 3 Promotor: Prof. dr. A. Rijnberk Co-promotoren: Dr. T.W. van Haeften Dr. H.S. Kooistra 4 The studies in this thesis were conducted and financially supported by the Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands. Printing of this thesis was financially supported by: A. Menarini Diagnostics Benelux AUV Dierenartsencoöperatie B. Braun Medical Eurovet Animal Health (Animal Pharm Awards Winner 2007) Intervet Merial Novartis Pfizer Animal Health Posthumafonds (Koninklijke Nederlandse Maatschappij voor Diergeneeskunde) Procter & Gamble Pet Care Proteq Dier en Zorg Verzekering Radiometer Nederland Druk: Ponsen en Looijen Slingerland, Lars Ingmar Risk factors for feline diabetes mellitus Lars Ingmar Slingerland, Utrecht Universiteit Utrecht, Faculteit Diergeneeskunde Thesis Universiteit Utrecht -- With references -- With summary in Dutch ISBN: 978-90-393-4742-3 Subject headings: diabetes mellitus, hyperglycemic glucose clamp,
    [Show full text]
  • The Effect of Cilostazol on Glucose Tolerance and Insulin Resistance in a Rat Model of Non-Insulin Dependent Diabetes Mellitus
    The Korean J ournal of Inte rnal Medicine Vol. 16, No. 2, J une , 2001 T h e Eff e ct o f C ilo s t a z o l o n G lu c o s e T o le r a n c e a n d In s u lin Re s is t a n c e in a Ra t M o d e l o f N o n - in s u lin De p e n d e nt Dia b e t e s M e llit u s S a n g A h C h a n g , M . D. , Bo n g Yu n C h a , M .D.*, S o o n J ib Yo o , M .D. , Yo o Ba e A h n , M .D., Ki Ho S o n g , M .D. , J e Ho Ha n , M .D., J o n g M in Le e , M .D. , Hy u n S ik S o n , M .D. , Ku n Ho Yo o n , M . D. , M o o IL Ka n g , M .D. , Kw a n g W o o Le e , M .D. , Ho Yo u n g S o n , M .D. , a n d S u n g Ku Ka n g , M .D. De p a rt m e nt of Inte rna l M e d ic ine , Cat ho lic Un iv e rs ity Me d ica l Co lle g e , S e o u l, Ko re a B a c kg ro u n d : It h as b e e n re p o rt e d t h at m a ny p e rip he ra l v a s o d ilat ing d rug s m ig ht im p ro v e ins u lin re s is t a n ce .
    [Show full text]
  • Glucose Metabolism in Patients with Psoriasis
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Copenhagen University Research Information System Glucose metabolism in patients with psoriasis Friis, N. U.; Hoffmann, N.; Gyldenlove, M.; Skov, L.; Vilsbøll, T.; Knop, F. K.; Storgaard, H. Published in: British Journal of Dermatology DOI: 10.1111/bjd.17349 Publication date: 2019 Document version Publisher's PDF, also known as Version of record Document license: CC BY Citation for published version (APA): Friis, N. U., Hoffmann, N., Gyldenlove, M., Skov, L., Vilsbøll, T., Knop, F. K., & Storgaard, H. (2019). Glucose metabolism in patients with psoriasis. British Journal of Dermatology, 180(2), 264-271. https://doi.org/10.1111/bjd.17349 Download date: 09. Oct. 2020 BJD REVIEW ARTICLE British Journal of Dermatology Glucose metabolism in patients with psoriasis* 1 1 2 2 1,3 1,3,4 1 N.U. Friis iD , N. Hoffmann, M. Gyldenløve, L. Skov iD , T. Vilsbøll iD , F.K. Knop iD and H. Storgaard iD 1Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte Hospital, Kildegardsvej 28, DK-2900 Hellerup, Denmark 2Department of Dermatology and Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark 3Department of Clinical Medicine and 4Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Summary Correspondence Background Epidemiological studies strongly suggest that psoriasis predisposes to Heidi Storgaard. type 2 diabetes. Several theories have been proposed to explain how these disease E-mail: [email protected] entities might be pathophysiologically connected. Objectives Our primary objective was to elucidate whether clinical data support the Accepted for publication 23 October 2018 notion of common pathophysiological denominators in patients with psoriasis and type 2 diabetes, and thus to delineate the association between the two condi- Funding sources tions that has arisen on the basis of epidemiological studies.
    [Show full text]
  • Validity and Reproducibility of HOMA-IR, 1/HOMA-IR, QUICKI and Mcauley’S Indices in Patients with Hypertension and Type II Diabetes
    Journal of Human Hypertension (2007) 21, 709–716 & 2007 Nature Publishing Group All rights reserved 0950-9240/07 $30.00 www.nature.com/jhh ORIGINAL ARTICLE Validity and reproducibility of HOMA-IR, 1/HOMA-IR, QUICKI and McAuley’s indices in patients with hypertension and type II diabetes PA Sarafidis1,2, AN Lasaridis1, PM Nilsson3, MI Pikilidou1, PC Stafilas1, A Kanaki1, K Kazakos1, J Yovos1 and GL Bakris2 11st Department of Medicine, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece; 2Hypertension/Clinical Research Center, Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA and 3Department of Medicine, Malmo¨ University Hospital, Lund University, Malmo¨, Sweden The aim of this study was to evaluate the validity and subjects’ body weight or fat-free mass and every other reliability of homeostasis model assessment-insulin clamp-derived index. 1/HOMA-IR and QUICKI indices resistance (HOMA-IR) index, its reciprocal (1/HOMA-IR), were positively correlated with the M-value (r ¼ 0.342, quantitative insulin sensitivity check index (QUICKI) and Po0.05 and r ¼ 0.456, Po0.01, respectively) and the rest McAuley’s index in hypertensive diabetic patients. In 78 clamp indices. McAuley’s index generally presented less patients with hypertension and type II diabetes glucose, strong correlations (r ¼ 0.317, Po0.05 with M-value). In insulin and triglyceride levels were determined after a multivariate analysis, HOMA-IR was the best fit of clamp- 12-h fast to calculate these indices, and insulin sensi- derived IS. Coefficients of variation between the two tivity (IS) was measured with the hyperinsulinemic visits were 23.5% for HOMA-IR, 19.2% for 1/HOMA-IR, euglycemic clamp technique.
    [Show full text]
  • Insulin Resistance in a Boy with Congenital Generalized Lipodystrophy
    003 1-399818812406-0668$02.00/0 PEDIATRIC RESEARCH Vol. 24, No. 6, 1988 Copyright O 1988 International Pediatric Research Foundation, Inc. Printed in U.S.A. Insulin Resistance in a Boy with Congenital Generalized Lipodystrophy HIROKAZU TSUKAHARA, KIYOSHI KIKUCHI, HIDESHI KUZUYA, EIKO ITO, YOKO ODA, ATSUSHI KOSAKI, TAKAKO KAKEHI, HARUO NISHIMURA, KAZUNURI YAMADA, YASUNAO YOSHIMASA, HIROO IMURA, AND HARUKI MIKAWA Department ofpediatrics [H.T. K.K., H.M.], Second Division, Department ofMedicine[H.K., A.K., T.K., H.N., K. Y., Y.Y., H.I.], Kyoto Municipal Toyo Hospital [E.Z., Y.0.1, Kyoto, Japan ABSTRACT. We have studied insulin resistance in a 12- CGL, a rare hereditary disease, was first documented by Ber- year-old Japanese boy who presented with congenital gen- ardinelli (I) and Seip (2). The clinical features are observed from eralized lipodystrophy. Oral glucose tolerance test exhib- birth or early infancy, and the hallmarks include a total lack of ited a diabetic pattern with normal fasting plasma glucose. fatty tissue, peculiar face, accelerated growth, muscular hypertro- Results from euglycemic glucose clamp study showed de- phy, acanthosis nigricans, hepatomegaly, and hypertrophied gen- creases in both insulin sensitivity and responsiveness. Both itals (1-10). In CGL, normal glucose tolerance is observed during the patient's erythrocytes and Epstein-Barr virus trans- the first few years of life. However, between the ages of 7 and 12 formed lymphocytes showed low-normal insulin binding yr, glucose intolerance ensues and insulin-resistant and nonke- with a slight reduction in binding affinity in the latter. totic diabetes mellitus develops in most cases (6-10).
    [Show full text]
  • Homeostasis Model Assessment Is a Reliable Indicator of Insulin Resistance During Follow-Up of Patients with Type 2 Diabetes
    Pathophysiology/Complications ORIGINAL ARTICLE Homeostasis Model Assessment Is a Reliable Indicator of Insulin Resistance During Follow-up of Patients With Type 2 Diabetes AKIRA KATSUKI, MD RIKA ARAKI-SASAKI, MD sex hormone–binding globulin (SHBG) YASUHIRO SUMIDA, MD YASUKO HORI, MD (2–10). Recently, the usefulness of HOMA- ESTEBAN C. GABAZZA, MD YUTAKA YANO, MD IR as an indicator of insulin resistance in SHUICHI MURASHIMA, MD YUKIHIKO ADACHI, MD diabetic patients has been the focus of MASAHIKO FURUTA, MD much attention (11–13). A significant cor- relation has been reported between the insulin resistance index calculated by HOMA and the hyperinsulinemic-eugly- cemic clamp (clamp IR) (11,12). OBJECTIVE — To investigate the usefulness of the homeostasis model assessment as an index We previously reported that the serum of insulin resistance (HOMA-IR) for evaluating the clinical course of patients with type 2 diabetes. levels of SHBG may be an index of insulin RESEARCH DESIGN AND METHODS — The usefulness of HOMA-IR and its rela- resistance only in the hyperinsulinemic state tionship with insulin resistance assessed by the hyperinsulinemic-euglycemic clamp study (before treatment) (7). The usefulness of (clamp IR) were evaluated in 55 Japanese patients with type 2 diabetes before and after treat- HOMA as an index of insulin resistance ment. The patients were subjected to diet (ϳ1,440–1,720 kcal/day) and exercise therapy (walk- during therapy of diabetes has not been as ing 10,000 steps daily) for 6 weeks during their hospitalization. yet evaluated. To evaluate this, in the pres- ent study, we investigated whether HOMA- RESULTS — Univariate regression analysis disclosed a significant correlation between log- IR is correlated with clamp IR before and Ϫ Ͻ transformed HOMA-IR and log-transformed clamp IR before (r = 0.613, P 0.0001) and after after treatment.
    [Show full text]
  • Improved Insulin Sensitivity with the Angiotensin II-Receptor Blocker Losartan in Patients with Hypertension and Other Cardiovascular Risk Factors
    Journal of Human Hypertension (2006) 20, 860–866 & 2006 Nature Publishing Group All rights reserved 0950-9240/06 $30.00 www.nature.com/jhh ORIGINAL ARTICLE Improved insulin sensitivity with the angiotensin II-receptor blocker losartan in patients with hypertension and other cardiovascular risk factors TA Aksnes1, HM Reims2, S Guptha3, A Moan4,IOs5 and SE Kjeldsen6 1Department of Cardiology, Ullevaal University Hospital, Oslo, Norway; 2Department of Cardiology, Ullevaal University Hospital, Oslo, Norway; 3Merck & Co., Whitehouse Station, New Jersey, USA; 4MSD AS, Drammen, Norway; 5Department of Nephrology, Ullevaal University Hospital, Oslo, Norway and 6Department of Cardiology, Ullevaal University Hospital, Oslo, Norway We aimed to compare the effects of two different a 4-week open-label wash-out phase, the participants vasodilating principles, angiotensin II-receptor blockade crossed over to the opposite treatment regimen and and calcium channel blockade, on peripheral insulin- final examinations with hyperinsulinaemic isoglycaemic mediated glucose uptake in patients with hypertension glucose clamp after another 8 weeks. Blood pressure and other cardiovascular risk factors. Twenty-one was lowered to the same level in both treatment periods. hypertensive patients (11 women and 10 men) with The glucose disposal rate was significantly higher after mean age 58.6 years (range 46–75 years), body mass treatment with losartan 100 mg þ amlodipine 5 mg com- index 29.271.0 kg/m2 and blood pressure 16073/ pared to amlodipine 10 mg (4.970.4 vs 4.270.5 mg/kg/ 9672 mm Hg entered a 4-week run-in period with min, P ¼ 0.039). Thus our data suggest that angiotensin open-label amlodipine 5 mg.
    [Show full text]
  • Zinc Supplementation for the Prevention of Type 2 Diabetes Mellitus (Review)
    Zinc supplementation for the prevention of type 2 diabetes mellitus (Review) Beletate V, El Dib R, Atallah ÁN This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2009, Issue 1 http://www.thecochranelibrary.com Zinc supplementation for the prevention of type 2 diabetes mellitus (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 2 OBJECTIVES ..................................... 3 METHODS ...................................... 3 RESULTS....................................... 6 DISCUSSION ..................................... 7 AUTHORS’CONCLUSIONS . 7 ACKNOWLEDGEMENTS . 7 REFERENCES ..................................... 8 CHARACTERISTICSOFSTUDIES . 9 DATAANDANALYSES. 11 WHAT’SNEW..................................... 11 HISTORY....................................... 12 CONTRIBUTIONSOFAUTHORS . 12 DECLARATIONSOFINTEREST . 12 SOURCESOFSUPPORT . 12 INDEXTERMS .................................... 12 Zinc supplementation for the prevention of type 2 diabetes mellitus (Review) i Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Review] Zinc supplementation for the prevention of type 2 diabetes mellitus Vânia Beletate1, Regina El Dib2, Álvaro N Atallah3 1Programa de graduacao de Medicina Interna e
    [Show full text]
  • Diagnostic Methods of Insulin Resistance in a Pediatric Population Azucena Martínez Basila, Jorge Maldonado Hernández and Mardia López Alarcón
    Bol Med Hosp Infant Mex 2011;68(5):367-373 pediatric theMe Diagnostic methods of insulin resistance in a pediatric population Azucena Martínez Basila, Jorge Maldonado Hernández and Mardia López Alarcón ABSTRACT Obesity is the main risk factor for insulin resistance (IR) in the pediatric population. IR represents a link between obesity and other metabolic complications such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Therefore, accurate diagnosis and early intervention may reduce the incidence of T2DM and CVD in at-risk individuals. In this study we describe the techniques used to assess insulin sensitivity in pediatric populations. We also describe in detail three diagnostic tests: the glucose clamp technique, which represents the gold standard to determine tissue insulin sensitivity and insulin secretion; HOMA and QUICKI, which are indexes obtained from fasting glucose and insulin concentrations; and ISI-Composite, obtained from an oral glucose tolerance test, which provides additional information on glucose metabolism after an oral glucose load. In conclusion, the glucose clamp technique is an invasive procedure that is difficult to use in routine clinical settings. Because the cut-off points to diagnose IR with values derived from ISI-Composite have not been established for pediatric populations, HOMA and QUICKI, despite their lack of precision, remain the most used in clinical practice. Key words: insulin resistance, diabetes mellitus, glucose. INTRODUCTION population5,6 because early diagnosis may reduce risks and delay onset of irreversible pathological entities. Obesity is the main risk factor for insulin resistance (IR) Insulin is a peptide hormone composed of 51 amino in the pediatric population.1 In Mexico, the national com- acids coded on the short arm of chromosome 11 and bined prevalence for overweight and obesity in children synthesized in the pancreas within β-cells in the islets of between 5 and 11 years old reaches 26%.
    [Show full text]
  • Carbohydrate Metabolism in the Elderly
    European Journal of Clinical Nutrition (2000) 54, Suppl 3, S112±S120 ß 2000 Macmillan Publishers Ltd All rights reserved 0954±3007/00 $15.00 www.nature.com/ejcn Carbohydrate metabolism in the elderly D Elahi1,2* and DC Muller2 1Massachusetts General Hospital, Geriatric Research Laboratory, Boston MA 02114, USA; and 2Gerontology Research Center, National Institute on Aging, Laboratory of Clinical Investigation, Baltimore MD 21224, USA In this short review we summarize the effect of age on glucose homeostasis. The concept of decreased glucose tolerance with increasing age is introduced, followed by evidence for this phenomenon. Speci®cally we review the evidence for changes in fasting glucose as a function of age and the effect of age on HbA1c. The role of age on hepatic glucose production and glucose uptake is then discussed in detail and we review the evidence that supports the concept that with advancing age hepatic glucose sensitivity to insulin is unaltered. We then review the large evidence for the role of age on the purported decrease in peripheral tissue sensitivity to insulin and conclude that the issue is unsettled. The decrease attributed to age is no longer signi®cant when confounders are controlled for, the largest being obesity. We next present evidence that b-cell sensitivity to glucose remains intact with aging. A review of age-related disorders due to hyperglycemia and confounding effects on the relationships of age and glucose tolerance is presented next. Finally we present new evidence that when the revised criteria for the diagnosis of type 2 diabetics as proposed by the American Diabetes Association and WHO are used, a greater percentage of the elderly will not be diagnosed.
    [Show full text]