Higher Insulin Levels Research Articles

Innovation in Hyperinsulinemia Diagnostics with ANN-L(atin square) Models.

Hyperinsulinemia is a condition characterized by excessively high levels of insulin in the bloodstream. It can exist for many years without any symptomatology. The research presented in this paper was conducted from 2019 to 2022 in cooperation with a health center in Serbia as a large cross-sectional observational study of adolescents of both genders using datasets collected from the field. Previously used analytical approaches of integrated and relevant clinical, hematological, biochemical, and other variables could not identify potential risk factors for developing hyperinsulinemia. This paper aims to present several different models using machine learning (ML) algorithms such as naive Bayes, decision tree, and random forest and compare them with a new methodology constructed based on artificial neural networks using Taguchi's orthogonal vector plans (ANN-L), a special extraction of Latin squares. Furthermore, the experimental part of this study showed that ANN-L models achieved an accuracy of 99.5% with less than seven iterations performed. Furthermore, the study provides valuable insights into the share of each risk factor contributing to the occurrence of hyperinsulinemia in adolescents, which is crucial for more precise and straightforward medical diagnoses. Preventing the risk of hyperinsulinemia in this age group is crucial for the well-being of the adolescents and society as a whole.

Application of serum pools in insulin harmonization: Commutability and stability.

Recalibration using serum pools assigned by higher-order reference methods had been demonstrated to be effective in improving the agreement among insulin immunoassays. To promote the application of serum pools in insulin harmonization, this study analyzed serum pools' commutability between insulin immunoassays, and their short- and long-term stability at different temperatures. The agreement between commonly used immunoassays was also evaluated. Insulin in 69 individual serum samples, 10 serum pools, and three EQA samples (lyophilized powder of serum pools) were detected by six widely used immunoassays. The commutability of serum pools and EQA samples was evaluated according to the IFCC-recommended approach. Serum pools' stability at different temperatures was investigated by placing them at various temperatures for varying lengths of time. Individual serum samples' results were analyzed using the Bland-Altman and Passing and Bablok regression analyses. Serum pools were commutable among most assays, the EQA samples-lyophilized serum pools-were non-commutable among most assays. Serum pools can be stably stored at -20°C and -80°C for at least one year, but can only be stably stored at room temperature for twenty-four hours. Significant relative differences were observed among assays. Recalibration using serum pools can only improve the assays' agreement at middle and high insulin levels, but not at low levels. Serum pools were commutable and stable for insulin measurement and can be used in insulin harmonization. The existing EQA materials were non-commutable between most assays, and other EQA materials, such as serum pools, should be studied.

The Insulin: Glucagon Ratio and Obesity.

This communication discusses the physiology and pathology of the insulin glucagon ratio, with respect to obesity. Though high insulin levels are associated with obesity in this manuscript the authors specifically highlight its role in the causation and clinical management of obesity. It suggests that the term insulin glucagon ratio be used in preference to glucagon insulin ratio, and shares insights which may be helpful in informing future research.

C-peptide level concomitant with hypoglycemia gives better performances than insulin for the diagnosis of endogenous hyperinsulinism: a single-center study of 159 fasting trials.

Diagnosis of endogenous hyperinsulinism relies on the occurrence of a hypoglycemia, concomitant with inadequate high insulin and C-peptide levels. However, diagnostic cutoffs are not consensual among the different learned societies. The objective of this work was to propose optimized cutoffs for these three parameters for the diagnosis of endogenous hyperinsulinism. All the patients having performed a fasting trial in Cochin Hospital Endocrinology Department between February 2012 and August 2022 were included. The results of glycemia, insulin and C-peptide levels during fasting trial were collected and analyzed. One hundred and fifty-nine patients were included: 26 with endogenous hyperinsulinism and 133 without endogenous hyperinsulinism. ROC analysis of glycemia nadir during fasting trial identified the value of 2.3 mmol/L as the optimal cutoff, ensuring a sensitivity of 100% associated with a specificity of 81%. ROC analysis of insulin and C-peptide levels concomitant with hypoglycemia <2.3 mmol/L showed very good diagnostic performances of both parameters with respective cutoffs of 3.1 mUI/L (=21.5 pmol/L; sensitivity = 96%; specificity = 92%) and 0.30 nmol/L (sensitivity = 96%; specificity = 100%). Insulin to glycemia ratio as well as C-peptide to glycemia ratio (in pmol/mmol) at the time of glycemia nadir did not show better diagnostic performances than C-peptide alone. A C-peptide level 0.3 nmol/L concomitant with a hypoglycemia <2.3 mmol/L appears as the best criterion to make the diagnosis of endogenous hyperinsulinism. Insulin level can be underestimated on hemolyzed blood samples, frequently observed in fasting trial, and thus shows lower diagnostic performances.

Observing the Use of Insulin Sensitizers for Ovulation Induction among PCOS Women

Introduction: In women of reproductive age, PCOS is a prevalent endocrine illness characterized by irregular menstrual cycles, many tiny ovarian cysts, and high levels of androgens. Insulin resistance is one of the leading causes of PCOS. Insulin sensitizers can help increase cells' sensitivity to insulin, allowing them to respond more effectively to insulin and transport glucose into the cells. Aim of the Study: The study's objective was to evaluate how PCOS women used insulin sensitizer as an ovulation inducer. Methods: This was a prospective, observational, cross-sectional research at the Manikganj 250 Bedded Sadar hospital, Dhaka, Bangladesh. The study duration was 1 year, from January 2022 to December 2022. During this period, 100 patients with PCOS were selected following the inclusion and exclusion criteria for their participation in this study. Result: The study population consisted of young individuals with a mean age of 24.91 years, a moderate-to-high body mass index of 26.79 kg/m2, a moderate waist-to-hip ratio of 0.82, high fasting insulin level of 21.00 µIU/mL, high insulin area under the curve (AUC) of 308.32, moderate luteinizing hormone (LH) level of 10.90 mIU/mL, moderate follicle-stimulating hormone (FSH) level of 5.43 mIU/mL, a high LH:FSH ratio of 2.02, and moderate free testosterone level of 2.72 pg/mL. After 4 months of treatment with metformin, 80% of the participants had ovulation induction, with 33% having at least one ovulation, 25% having 2 ovulations, and 6% having 4 ovulations. After continuous treatment with metformin for 16 weeks, the study population had a mean body mass index of 26.22 kg/m2, a moderate waist-to-hip ratio of 0.81, low fasting insulin level of 10.55 µIU/mL, low insulin area under the curve (AUC) of 183.00, low to moderate luteinizing hormone (LH) level of 5.32 mIU/mL, moderate follicle- stimulating hormone (FSH) level of 4.80 mIU/mL, a low LH:FSH ratio of 1.10, and low free testosterone level of 1.33 pg/mL. .....

Whipple's triad with high and low insulin levels

A69-year-old female patient and a70-year-old male patient were admitted to hospital with recurrent, severe hypoglycemic episodes and atypical manifestation of Whipple's triad. In the female, elevated levels of insulin, C‑peptide and pro-insulin together with pathological findings during afasting test proved the presence of an insulinoma, which could be detected by Ga-68-DOTATOC-PET-CT in the pancreas. There was avery rare co-existence of aneuroendocrine Merkel cell carcinoma. In the male, levels of insulin and C‑peptide were suppressed and adiagnosis of paraneoplastic hypoglycemia by IGF‑2 secretion was made with increased glucose disposal in skeletal muscle proven by 18F‑FDG-PET-CT.

Glycemic and Insulin Status in Periodontitis Patients using the Homeostasis Model Assessment (HOMA): A Pilot Study.

This study aimed to compare insulin status and dysglycemia (prediabetes/diabetes) of patients with chronic (stage III, grade B) or aggressive periodontitis (stage III, grade C) to that of a healthy population. Patients with chronic (CP, n = 16) or aggressive periodontitis (AP, n = 15) and periodontally healthy controls (n = 32) were recruited. Body mass index was calculated. Glycemia, plasma insulin, glycated hemoglobin, C-reactive protein, and lipid levels were measured in fasting. The Homeostasis Model Assessment was used to calculate the insulin sensitivity (HOMA-%S), the beta-cell function (HOMA-%B), and their hyperbolic product (HOMA-%BxS). The CP group showed statistically significantly insulin resistance with a lower HOMA-%S (p = 0.0003) and a reduced HOMA-%BxS (p = 0.049) despite a higher insulin level (p = 0.01) vs the control group, even after BMI adjustment. There was also a trend to dysglycemia (prediabetes/diabetes) in the chronic group. In patients with AP, no abnormalities in insulin status were observed and glycemic levels were comparable with controls. Additionally, patients in both AP and CP groups presented significantly higher CRP levels compared to those of the control group (p = 0.02). Patients with CP showed reduced insulin sensitivity, increased insulin levels but a reduced %BxS product and a trend to dysglycemia. These abnormalities were not observed in AP.

A Simple Estimate of Visceral Fat Area by Multifrequency Bioimpedance Analysis Is Associated with Multiple Biomarkers of Inflammation and Cardiometabolic Disease: A Pilot Study

There is a need for identifying whether simple techniques for estimating visceral fat can accurately predict inflammatory and cardiometabolic disease (CMD) biomarkers in various populations. We aimed to determine whether a simple estimate of visceral fat area by multifrequency bioelectrical impedance analysis (MFBIA) was independently associated with multiple biomarkers of inflammation and CMD. Seventy-eight men and women (mean ± SD: age 52.0 ± 10.8 y; visceral fat area 105.6 ± 55.0 cm2) self-reported their medical histories and activity levels. Visceral fat area was estimated with MFBIA, CMD and inflammatory biomarkers were measured by fasting blood draw, and homeostasis model assessment for insulin resistance (HOMA-IR) was calculated. Associations were assessed using multivariable linear regression. With adjustment for age, sex, height, race/ethnicity, family history of diabetes, and smoking, a 1-standard deviation (1-SD) increase in visceral fat (55 cm2) was associated with higher levels of insulin (60.4%), triglycerides (43.6%), C-reactive protein (38.7%), interleukin-6 (33.9%), leptin (77.9%), and HOMA-IR (51.8%, p &lt; 0.01 for all). These associations were attenuated but remained significant when physical activity and sedentary behavior were entered into the model (p ≤ 0.01). These findings suggest that a simple estimate of visceral fat area by MFBIA may be a good indicator of increased CMD risk and may be useful in clinical practice.

THE PROBABLE RELATION BETWEEN TOXOPLASMA GONDII AND DIABETES MELLITUS

&#x0D; &#x0D; &#x0D; Present study aims to determine probable relation between Toxoplasma gondii infection and diabetes mellitus by investigating serum levels of insulin and anti-Toxoplasma antibodies through ELISA among diabetic and non-diabetic persons in Lahore, Pakistan. Results showed that insulin level was higher in subjects positive for Toxoplasma infection as compared to Toxoplasma free one’s (p&lt;0.05). The analysis revealed that Toxoplasma infection was more prevalent in diabetic patients (p&lt;0.05) than non-diabetic individuals. Results also showed that insulin level was higher in persons with chronic infection. Gender-wise comparison revealed that in males, insulin level had significant association with Toxoplasma infection (p&lt;0.05). It was concluded that participants who had Toxoplasma infection had higher insulin level that showed the probable relation of infection with diabetes.&#x0D; &#x0D; &#x0D;

ВЫЯВЛЕНИЕ ГРУПП РИСКА НАПРЯЖЕНИЯ ЭНДОКРИННОЙ СИСТЕМЫ ПРИ РАБОТЕ НА ЦЕЛЛЮЛОЗНО-БУМАЖНОМ КОМБИНАТЕ АРХАНГЕЛЬСКОЙ ОБЛАСТИ

We examined male employees at a pulp and paper mill in Arkhangelsk to define risk groups based on frequency of deviations in the main endocrine parameters, i.e. cortisol, thyroxin (Т4), thriiodothyronine (Т3), insulin, somatotropin (STH) and tiroxin-binding globulin (TBG). The control was males who had not worked in the extreme production environment. The investigation stated functional changes in the endocrine system of the PPM employees. These include an exaggerated activity of the pancreas, increased STH production, and misbalance in thyroid hormones with increased levels of Т4 and decreased Т3. Contributing factors were age and work experience, as well as place of residence prior to the employment. Groups of the risk to develop de-adaptive states are 22–25 y.o. people with increased cortisol and decreased STH; 36–50 y.o. people with increased Т4, insulin and STH, and low Т3; people with work experience of 11–15 yrs. and high levels of cortisol, Т4 and somatotropin; people with work experience more than 16 yrs. with high levels of insulin, STH and low Т3level; employees migrated from south regions of this country.

AW-AD-4: RENOPROTECTIVE EFFECTS OF CANAGLIFLOZIN VIA LESSENING HYPERINSULINEMIA IN DIABETIC PATIENTS WITH HEART FAILURE: A POST-HOC ANALYSIS OF THE CANDLE TRIAL

Objective: The mechanisms by which sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce proteinuria in patients with type 2 diabetes mellitus (T2DM) remain unclarified. We evaluated factors associated with proteinuria regression in patients with T2DM treated with canagliflozin. Design and method: This study was a post-hoc analysis of the CANDLE trial (UMIN000017669), which compared the effect of 24 weeks treatment canagliflozin and glimepiride for changes in NT-proBNP in patients with T2DM and chronic heart failure (CHF). Factors associated with regression of proteinuria at 24 weeks were evaluated with multivariate logistic models. Results: The rate of regression of proteinuria was higher and that of progression was lower in the canagliflozin versus the glimepiride group. There were no differences in the change in systolic and diastolic blood pressure and eGFR category between groups at baseline. Systolic blood pressure and insulin levels significantly decreased in the canagliflozin group but not in the glimepiride group. Insulin level, HOMA-β, HOMA-IR, and estimated plasma volume were decreased at 24 weeks in the proteinuria regression subclass but not in the proteinuria progression subclass, suggesting that regression of proteinuria is associated with the declines in these values in the canagliflozin group. Systolic and diastolic blood pressure did not change significantly in either the proteinuria progression or regression groups in both the canagliflozin and glimepiride groups. Higher insulin level was solely associated with proteinuria regression in the multivariate logistic regression model. Conclusion: In patients with T2DM and CHF, regression of proteinuria with canagliflozin treatment was associated with the pre-treatment insulin level. These results suggest new mechanistic intuitions into the beneficial effects of canagliflozin on renal outcomes and warrant discussion for selecting preferred patient profiles, including pre-treatment insulin levels.

EFFECTIVENESS OF СOMBINED REHABILITATION THERAPY IN KIDS WITH METABOLIC SYNDROME

Abstract The work carried out a multivariate study of the mechanisms of metabolic disorders, closely related to an increase in blood pressure in children with arterial hypertension from 10 to 17 years. For this purpose, 60 children with arterial hypertension and metabolic disorders were examined. 20 children made up the control group. Before and after spa treatment, all children underwent a set of clinical and laboratory examinations, which included daily monitoring of blood pressure, biochemical studies of lipid and carbohydrate profiles, insulin, insulin resistance indices HOMO and CARO, leptin, adiponectin. Besides the individual hypocaloric diet, the rehabilitation included proper physical activity, school of arterial hypertension, not allowing for a child to sit at the computer or watch TV for a long time (or at all), treatment of foci of chronic infection (including pelotherapy and inhalations), sedative aero-phytotherapy, aero-ionotherapy, exercise therapy in either arterial hypertension or obesity group, classical hand massage of the neck and shoulders, electrosleep therapy. Depending on the treatment received the children with arterial hypertension (n=60) were divided into three groups (using the method of simple randomisation). The use of balneotherapy and electrosleep therapy in complex spa treatment contributes to the normalization of initially disturbed biochemical carbohydrate and lipid metabolic markers, a decrease in high levels of leptin and insulin, and an increase in initially reduced adiponectin. This allows us to conclude that the combined sanatorium-resort rehabilitation of patients is highly effective, which is expressed in a decrease in blood pressure, body weight, indicators of fat and carbohydrate metabolism. Intensive spa treatment has a beneficial effect on changing the criteria for the development of MS in children with obesity and hypertension. Of course, to achieve the optimal effect in the correction of disorders of carbohydrate and lipid metabolism, a long period of therapeutic measures and observation of patients is required, at least 3-6 months.

PS-R03-5: HYPOTENSIVE AND HYPERGLYCEMIC EFFECTS OF DIAZOXIDE IN A CASE OF INSULINOMA

Case report: We report the case of sporadic insulinoma in a 70-year-old female with breast cancer and hypertension treated by irbesartan 100 mg and benidipine 8 mg, who presented with a 1-month history of episodic tremulousness, diaphoresis, increased hunger, confusion and fainting. Initial laboratory investigations showed low blood glucose (21 mg/dL) and high blood insulin (107 μU/mL) levels. The hypoglycemic symptoms were relieved greatly by glucose administration and Whipple's triad for insulinoma was met. An abdominal contrast-enhanced computed tomography scan showed a 12 mm, small, well demarcated, heterogeneously enhancing lesion within the tail of pancreas without dilatation of pancreatic duct. The site also showed a well-defined accumulation of boundaries on PET-CT. Patient was diagnosed with insulinoma. Since Patient did not initially wish to undergo surgery, blood glucose control was performed by taking diazoxide 225 mg, gradually reduced to 50 mg. Before and after taking diazoxide, blood glucose increased from 75 ± 40 mg/dL to 124 ± 35 mg/dL significantly (p &lt; 0.05). On the other hand, blood pressure was significantly reduced from 141 ± 3/78 ± 3 mmHg to 126 ± 3/75 ± 3 mmHg. Benidipine was withdrawn to about 130/80 mmHg. Then, Patient changed her mind and underwent laparoscopic caudal pancreatic resection. Histopathological examination of the pancreatic mass confirmed neuroendocrine tumor (insulinoma). Patient had an uneventful recovery. Blood pressure re-increased above 140/90 mmHg and benidipine was resumed. Although diazoxide suppresses insulin secretion in the pancreas due to its KATP channel opening action and improves hypoglycemic attacks with insulinoma, it also acts on the KATP channel of vascular smooth muscle and show a hypotensive effect. It is important to pay close attention not only to blood glucose but also to blood pressure fluctuations when using diazoxide.

PS-C06-1: ELEVATED PULSE PRESSURE AND SERUM INSULIN ARE INDEPENDENTLY ASSOCIATED WITH DIABETIC RETINOPATHY IN DIABETIC WOMEN WITH OR WITHOUT SYSTEMIC HYPERTENSION

Objective: Diabetic retinopathy (DR) is a major cause of vision loss, creating a low quality of life in patients. High blood pressure and serum insulin levels are known to be associated with DR. Though incident diabetic eye disease is reportedly related to systolic blood pressure (SBP), the potential importance of pulse pressure (PP) is not clear. The present study aimed at determining the association between pulse pressure, serum insulin levels and diabetic retinopathy in type 2 diabetes (T2DM) with or without systemic hypertension. Design and Method: Cross-sectional hospital-based study involving type 2 DM female patients with (n = 70) or without systemic hypertension (n = 36). The groups were matched for age, sex and BMI. Anthropometric measurements were taken, fasting blood glucose, glycated hemoglobin, serum insulin, and lipid profile were determined. Results: The mean values for weight and BMI were comparable between the groups, however, DBP, SBP, PP and serum insulin were significantly higher in the hypertensive diabetics. Using multiple regression (stepwise) analysis, there was a strong relationship between PP and DR in hypertensive diabetics (β = 2.239, p &lt; 0.000, R2 = 0.143) while serum insulin showed a strong relationship with DR in patients with only T2DM (β = 2.190, p &lt; 0.000, R2 = 0.253). Receiver operating characteristics (ROC) curve showed that PP with area under the curve (AUC) of 0.746 in hypertensive diabetics and serum insulin with AUC of 0.784 in patients with only T2DM were the most efficient predictors of DR respectively. Conclusions: The findings in the present study indicate that elevated PP and serum insulin could be reliable independent predictors of DR in T2DM female patients with or without systemic hypertension respectively.

Evaluating the Body Mass Index, Blood Glucose, and Serum Insulin in Adolescent Acne

Background: Acne is one of the most common skin diseases affecting the pilosebaceous unit that is seen in adolescents mainly. The pathogenesis is multifactorial. High glycemic food, milk and dairy products, and sedentary lifestyle lead to high body mass index (BMI) and high serum insulin levels. These ultimately converge on mammalian target of rapamycin complex 1 activation, leading to acne genesis. There are few studies correlating the acne with BMI, serum insulin, and fasting blood glucose. Aim: To evaluate the BMI, fasting blood glucose, and serum insulin levels of adolescent acne vulgaris patients and compare it with controls. Materials and Methods: One hundred cases of acne vulgaris and age- and sex-matched controls were included in the study. Their BMI was calculated and fasting blood glucose and serum insulin levels were measured. Results: Mean BMI, fasting blood glucose, and serum insulin were higher among cases than controls. All the outcomes were statistically significant. Conclusion: Dermatologists should also focus on improving the dietary and lifestyle in their acne patients, rather than just treating the disease per se.

Can the triglyceride-glucose index predict insulin resistance in LGA newborns?

The aim of this study is to investigate the TyG index and TG/HDL-C ratio and their relationships with insulin resistance in LGA infants. A prospective controlled study was conducted including 65 LGA and gestational age, gender-matched appropriate for gestational age (AGA) neonates. Serum TG, total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), insulin and glucose levels were measured within two hours after birth, TyG index and HOMA-IR values were calculated. TyG index and TG/HDL- C ratio were higher in LGA neonates compared to AGA ones (p = 0.03; p = 0.00, respectively). Compared with AGA newborns, LGA newborns had higher levels of insulin and HOMA-IR (p = 0.00; p = 0.00, respectively). TyG index and TG/HDL-C ratio showed moderate correlation with HOMA-IR (r = 0.59 R2 = 0.35 p < 0.001; r = 0.5 R2 = 0.25 p < 0.001, respectively). CONCLUSıON: The results of this study show that LGA newborns have increased levels of TyG index and TG/HDL-C associated with insulin resistance.

Serum biomarkers of colonic polyps in patients with acromegaly: a meta-analysis and systematic review.

In the past few decades, acromegaly and colonic polyps have been associated with an increased risk of colorectal cancer. Previous studies highlighted the importance of serum biomarkers of colonic polyps in patients with acromegaly. We reviewed studies on serum biomarkers of colonic polyps in patients with acromegaly, published on PubMed, Embase, Cochrane Library, Medline, and Chinese databases from January 1, 1966, to May 8, 2022. Meta-analysis and systematic review were conducted using Stata MP 14.0. Eight articles were included in this study. The mean (standard deviation) concentrations of serum biomarkers for acromegaly with and without colorectal polyps were extracted from these studies. Meta-analysis results showed that, compared to patients without colonic polyps, the levels of insulin-like growth factor-1 × upper limit of normal range (IGF-1 × ULN) and fasting insulin were significantly increased; while the levels of growth hormone (GH) were significantly decreased in patients with acromegaly and colonic polyps (IGF-1 × ULN: SMD 0.23; 95% CI 0.03-0.42, p < 0.05) (fasting insulin: SMD 0.95; 9 5% CI 0.11-1.8, p < 0.05) (GH: SMD - 0.25; 95% CI - 0.41 to - 0.08, p < 0.05). IGF-1 and FPG levels did not differ significantly (IGF-1: SMD -0.03; 95% CI - 0.22 to 0.17, p > 0.05) (FPG: SMD 0.14; 95% CI - 0.23 to 0.52, p > 0.05). The systematic review results suggest no significant differences in hemoglobin A1C, TSH, free thyroxine, FT4, T3, PRL, total cholesterol, HDL, LDL, fibrinogen, clathrate antigen, serum antigen 19-9, and α-fetoprotein levels, but serum Klotho levels. We present the first meta-analysis and systematic review of serum biomarkers in patients with acromegaly or colonic polyps. The prevalence of colonic lesion polyps, is associated with higher IGF-1 × ULN levels, higher insulin levels in acromegaly. Further research is required to confirm GH and serum soluble Klotho levels as biomarkers of colonic polyps. When IGF-1 × ULN, fasting insulin levels change in patients with acromegaly, the occurrence of colonic polyps should be monitored. Early detection may reduce the possibility of developing malignant colon neoplasms.

Comparison of Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) and the Level of Cortisol Between Preterm and Term Newborns.

Introduction According to the thrifty (Barker's) phenotype hypothesis, poor nutrition in fetal and early infancy plays a role in the development and function of the beta cells of the islets of Langerhans, which leads to the development of type 2 diabetes mellitus. Insulin resistance is due to decreased suppressive effect of insulin on hepatic glucose production. Thus, elevated insulin levels during perinatal life may predispose the infant to the development of diabetes mellitus in future life. Intrauterine undernutrition plays an important role in causing adult insulin resistance and diabetes but the exact cause is still unknown. Preterm infants born small for gestational age (SGA) show lower adrenocortical response to stimulation due to an immature hypothalamic-pituitary axis. Methods The cross-sectional study conducted at Rajendra Institute of Medical Sciences, Ranchi from June 2020 to November 2021 included 216 newborns enrolled as per the inclusion and exclusion criteria. Maternal and neonatal details were collected at birth and recorded. Cord blood samples for measurement of serum insulin, glucose, and cortisol were collected from 84 preterm and 132 term neonates. Using this information, homeostasis model assessment-insulin resistance (HOMA-IR) was calculated using a mathematical formula. Insulin resistance was defined asHOMA-IR > 2.5.Based on birth weight and gestational age, they were further categorized into SGA, appropriate for gestational age (AGA), and large for gestational age (LGA). The parametric data were presented as means ± standard deviation (SD), and nonparametric data as medians (first quartile and third quartile). The Student's (independent samples) t-test and Mann-Whitney U test were used to compare mean differences between the two groups forparametric and nonparametric data, respectively. The Spearman correlation coefficient was used to determine the significant association between variables. Results Umbilical cord plasma glucose and serum insulin were high in preterm in comparison to term newborns. Serum cortisol levels were high in term than in preterm newborns. HOMA-IR showed a very strong positive correlation with serum insulin and a moderate positive correlation with serum glucose. HOMA-IR showed a strong negative correlation with gestational age and a moderate negative correlation with birth weight. Insulin resistance was seen in 34 preterm newborns and two term newborns. Insulin resistancewas seen in 29.8% (n = 25) of SGA preterm babies, 7.1% (n = 6) of AGA preterm babies, and 1.5% (n = 2) of AGA term newborns. A total of 55.6% of newborns were below normal weight (48.1% had low birth weight, 4.6% had very low birth weight, and 2.8% had extremelylow birth weight). Conclusion Our study suggests that preterm newborns are more insulin resistant at birth than term newborns. SGA preterm babies are having a higher incidence of insulin resistance compared to AGA preterm babies. It is clear that high insulin level is needed to overcome high insulin resistance in the very early gestational period. Serum cortisol increases as gestational age and birth weight increase. Thus, serum cortisol helps in the maturation of the fetus and neonatal adaptation at birth.

Association of muscle mass measured by D3-Creatine (D3Cr), sarcopenic obesity, and insulin-glucose homeostasis in postmenopausal women.

The D3-Creatine (D3Cr) dilution method is a direct and accurate measure of skeletal muscle mass. In this study, we examined the association of D3Cr muscle mass with measures of insulin-glucose homeostasis in community dwelling postmenopausal women. Additionally, we examined association of sarcopenic obesity, defined as low D3Cr muscle mass and high percent body fat, with fasting plasma glucose, insulin, hemoglobin A1c and insulin resistance. Insulin resistance was measured by the homeostatic measure of insulin resistance (HOMA-IR). This pilot study included 74 participants (mean age = 82.3 years) from the Women's Health Initiative-Buffalo site. The D3Cr method was initiated at a clinic visit and used to measure muscle mass via remote urine sample collection. Descriptive and graphical approaches and age-adjusted linear regression models were used to analyze study data. We examined muscle mass as an absolute value (kg) and scaled to body weight (D3Cr muscle mass/kg). There was an inverse relationship between skeletal muscle mass, and impaired insulin-glucose homeostasis. Women with low muscle mass had higher levels of insulin (uIU/mL; β = -0.40; 95% CI: -0.79, -0.01), fasting plasma glucose (mg/dL; β = -0.1; 95% CI: -0.2, 0.03), HbA1c (%; β = -2.30; 95% CI: -5.7, 1.1), and calculated homeostatic model of insulin resistance, HOMA-IR, (β = -1.49; 95% CI: -2.9, -0.1). Sarcopenic obesity was common in this population of women; 41% of participants were categorized as having low muscle mass and high percent body fat. Results demonstrate that D3Cr muscle mass is independently associated with measures of insulin-glucose homeostasis, but obesity is a stronger predictor of insulin resistance than muscle mass.

Continuous glucose monitoring reveals similar glycemic variability in individuals with obesity despite increased HOMA-IR.

Continuous glucose monitoring is a well-tolerated and versatile tool for management of diabetes and metabolic disease. While its use appears to be feasible to monitor glycemic profiles in diabetics, there is a paucity of data in individuals with obesity and normal glucose tolerance. The aim of this study is to investigate glucose fluctuations and insulin resistance patterns in normoglycemic participants with obesity vs. without obesity and contextualize these results against leading models for obesity. We designed a prospective, observational pilot study of two cohorts including 14 normoglycemic participants with obesity and 14 normoglycemic participants without obesity. Participants were monitored with continuous glucose monitoring (CGM) for five consecutive days. Insulin resistance levels were measured and glucometric data were extracted from CGM for all participants. Fasting serum insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were significantly higher in the group with obesity (P < 0.05). While the group with obesity had a higher mean blood glucose (MBG), mean amplitude of glycemic excursions (MAGE), and continuous overall glycemic action-1 h (CONGA-1), these differences were not significant. On univariate linear regression, insulin resistance (HOMA-IR) was associated with body mass index (BMI), waist circumference (WC), cohort with obesity, cohort consuming a high glycemic diet, hemoglobin A1c (HbA1c), and fasting insulin levels. WC and fasting insulin levels remained predictors of HOMA-IR in our multivariable model. While there is much excitement surrounding the use of commercial CGM products in obesity management, our results suggest that fasting insulin and HOMA-IR values may be more clinically useful than CGM data alone.