Homeostasis Model Assessment Of Insulin Resistance Levels Research Articles

Impact of walnut consumption on glycemic control and anthropometric indices: a systematic review and meta-analysis of randomized controlled trials.

Previous studies have led to conflicting results regarding the effect of walnut consumption on glycemic control, and anthropometric indices. This study aimed to evaluate the efficacy of walnut consumption on serum levels of fasting blood sugar (FBS), fasting insulin, hemoglobin A1C (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), weight and body mass index (BMI) through a systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, Scopus, Web of Science, and the Cochrane databases were searched up to February 2023. Weighted mean difference (WMD) was analyzed using random effects models to assess the overall effect. A total of thirty-two RCTs were included in the systematic review and meta-analysis. Walnut supplementation was found to significantly reduce HOMA-IR (WMD = -0.29; 95% CI: -0.57, -0.01, P = 0.04), and body weight (WMD = -0.14kg; 95% CI: -0.24, -0.04; P = 0.008). However, the meta-analysis showed that walnut supplementation did not have a significant effect on FBS (WMD = 0.62 mg/dL; 95% CI: -0.66, 1.91; P = 0.34), insulin levels (WMD = 1.27 mIU/ml; 95% CI: -0.59, 3.14; P = 0.18), HbA1C (WMD = 0.00%; 95% CI: -0.09, 0.10; P = 0.95), and BMI (WMD = -0.10 kg/m2; 95% CI: -0.40, 0.20; P = 0.50). In conclusion, this study found a significant reduction in HOMA-IR levels and body weight with walnut supplementation, while other glycemic markers, and obesity-related indices did not change significantly. Future well-designed trials are needed to confirm these results.

Changes in Prolactin and Insulin Resistance in PCOS Patients Undergoing Metformin Treatment: A Retrospective Study

Background: Prolactin levels have been shown to influence metabolic outcomes, including insulin resistance. Metformin is known to be beneficial in polycystic ovary syndrome (PCOS) patients. PCOS women might react differently to metformin treatment depending on their baseline prolactin levels. Methods: In this retrospective study, the homeostasis model assessment for insulin resistance (HOMA-IR), prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), the LH:FSH ratio, and total testosterone and sex hormone-binding globulin (SHBG) were measured in 75 obese/overweight women with PCOS and insulin resistance before initiation of metformin treatment and after 6–8 months. Results: At baseline, HOMA-IR was inversely correlated to SHBG (r = −0.408; p < 0.001) and prolactin (r = −0.402; p < 0.001). After 6–8 months of metformin treatment, the LH:FSH ratio and the HOMA-IR declined significantly (p < 0.05). A significant positive correlation could be shown between basal prolactin and the difference in the HOMA-IR (r = 0.233; p = 0.044). Women with lower baseline prolactin (≤14.9 ng/mL) revealed a sharper decline in HOMA-IR (−0.8, IQR −1.0; −0.5 vs. −0.6, IQR −0.8; −0.3; p = 0.049) as well as an increase in prolactin at follow-up (1.6 ng/mL, IQR −0.2;3.8 vs. −1.3, IQR −4.6;3.2; p = 0.003) compared to patients with a baseline prolactin > 14.9 ng/mL. Conclusions: In overweight/obese, insulin-resistant PCOS women, lower baseline prolactin levels are associated with higher baseline HOMA-IR levels as well as with a better response to metformin treatment. More data are necessary to prove these observations in larger populations.

The association of objective daytime sleepiness with impaired glucose metabolism in patients with obstructive sleep apnea: a multi-omics study.

To examine the joint effect of obstructive sleep apnea (OSA) and objective excessive daytime sleepiness (EDS) on glucose metabolism and the underlying mechanisms. We included 127 patients with OSA. The multiple sleep latency test (MSLT) and Epworth sleepiness scale (ESS) were used to assess objective and subjective EDS, respectively. Disordered glucose metabolism was defined as either a physician diagnosis or having fasting blood glucose levels ≥ 5.6 mmol/L. Values of fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) higher than the median values of our sample were defined as high fasting insulin and insulin resistance. Serum metabolomics and fecal microbiota were used to explore underlying mechanisms. Lower MSLT values were associated with higher levels of fasting blood glucose, fasting insulin, and HOMA-IR. Furthermore, objective EDS was associated with increased odds of disordered glucose metabolism, elevated fasting insulin, and insulin resistance. Dysregulation of serum valine degradation and dysbiosis of fecal Bacteroides thetaiotaomicron were associated with impaired glucose metabolism in OSA with objective EDS. No association between subjective EDS and impaired glucose metabolism was observed. OSA with objective, but not subjective, EDS is associated with an increased risk of disordered glucose metabolism and insulin resistance. Dysregulation of valine degradation and dysbiosis of Bacteroides thetaiotaomicron appear to link objective EDS and disordered glucose metabolism in OSA.

Gestational diabetes mellitus (GDM): diagnosis using biochemical parameters and anthropometric measurements during the first trimester in the Indian population.

The objective of the study was to use anthropometric measurements (age, BMI, and subcutaneous fat) inconjunction with biochemical parameters (sex hormone-binding globulin (SHBG), homeostasis model assessment-insulin resistance (HOMA-IR), fasting glucose, serum insulin, and total cholesterol) to predict the probability of gestational diabetes mellitus (GDM) in the first trimester. The study enrolled 48 pregnant women with GDM and 64 high-risk pregnant women without GDM. During the first-trimester examination, maternal blood samples were collected to measure SHBG, fasting blood glucose, serum insulin, and total cholesterol levels. Regression model analysis was used to examine the variables that showed statistically significant differences between the groups and were independent predictors of GDM. Receiver operating characteristic (ROC) curve analysis was employed to determine the risk of developing GDM based on cut-off values. The levels of SHBG, HOMA-IR, serum insulin, fasting glucose, and total cholesterol were identified as significant independent markers for predicting GDM. Meanwhile, age, body mass index, and subcutaneous fat values were found to be non-independent predictors of GDM. The areas under the ROC curve were calculated to determine the predictive accuracy of total cholesterol, HOMA-IR, SHBG, and subcutaneous fat for developing into GDM, and were 0.869, 0.977, 0.868, and 0.822 respectively. The sensitivities for a false positive rate of 5 % for predicting GDM were 68.7 , 91.67, 91.7, and 97.9 % for total cholesterol, HOMA-IR, SHBG, and subcutaneous fat, respectively. The independent predictors for the subsequent development of GDM in high-risk pregnancies are HOMA-IR, SHBG, Total cholesterol, and subcutaneous fat (SC) levels. These parameters can be used to create a regression model to predict the occurrence of GDM.

Evaluation of retinal nerve fiber layer and choroidal structure in obese children and adolescents

Aim: Obesity-related vascular damage and endothelial dysfunction have deleterious effects on the ocular vasculature. It was aimed to examine optical coherence tomography (OCT) parameters in obese and overweight children and to define their relationship with metabolic markers in this study. Methods: The patient group consisted of 26 obese, 24 overweight patients aged between 8 and 18 years. The control group consisted of 25 healthy children with normal body mass index (BMI). This was a cross-sectional observational study. Serum glucose, lipid parameters, and homeostasis model assessment of insulin resistance (HOMA-IR) were investigated. Measurement of choroidal thickness was performed with Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, USA). Retinal nerve fiber layer (RNFL) thickness was determined by an automatic computer algorithm without the need for user measurement. Results: There were no differences in subfoveal, nasal, temporal choroidal thickness, and RNFL between obese, overweight, and control groups (p>0.05). A positive (linear) moderate relationship was found between RNFL and the HOMA-IR of 26 patients in the obese group (r=0.389) (p=0.049). A positively weak correlation was found between height and RNFL in obese patient group (r=0.264, p=0.028). Conclusion: In the study, RNFL thickness increased as HOMA-IR level increased in obese children and adolescents. RNFL decreased as the height increased in obese children and adolescents. We believe that more comprehensive data about the effect of obesity on RNFL and choroidal thickness will be obtained with prospective studies in which the obese patient group with insulin resistance is taken separately and disease durations are defined, and long-term patient follow-up is performed.

Correlation Between Diverse Smoking Habits and the Risk of Developing Type 2 Diabetes: A Comparative Analysis.

Diabetes mellitus (DM) is a prevalent metabolic illness that arises as a result of a complex interplay between genetic predisposition, environmental influences, and lifestyle choices. The precise mechanisms elucidating the association between smoking and the onset of DMremain incompletely understood, despite the proposal of several ideas. The objective of this study ‎was to conduct a comparative analysis of blood glucose levels, hemoglobin A1c (HbA1c) levels, insulin hormone levels, and homeostasis model assessment of insulin resistance (HOMA-IR) ‎levels in diabetic patients who smoked and those who did not. The study included a total of 320 volunteers divided into four groups, with each group consisting of 80 volunteers. The first group served as the control group and consisted of ‎healthy individuals. The remaining three groups consisted of type 2 diabetes mellitus (T2DM) patients, categorized based on their smoking habits. The second ‎group comprised T2DM patients who did not smoke, the third group consisted of T2‎DM patients who smoked cigarettes, and the fourth group included T2DM patients ‎who smoked e-cigarettes.‎At recruitment, data on age, fat %, waist circumference (cm), and body mass index (kg/m2) was collected. Biochemical markers measured were fasting blood glucose (FBG), HbA1c, insulin, and HOMA-IR‎ levels. The findings demonstrated a statistically significant increase (P<0.001) in the levels of each parameter, particularly among patients with T2DM who engaged in e-cigarette smoking, compared to the control group.‎ It was found that engaging in dual smoking, which involves the use of both traditional cigarettes and e-cigarettes, was associated with a higher likelihood of elevated HbA1c levels and other negative health effects. When it comes to the management of diabetic patients, abstaining from smoking and participating in smoking cessation programs, for patients who smoke, should be the essential approaches. It was found that dual smokingled to a higher likelihood of elevated HbA1c levels and this association was most pronounced among male individuals, those who were physically inactive, and thoseclassified as obese. Further studies should be conducted on the detrimental health consequences associated with e-cigarettes, with a particular focus on enhancing the awareness of healthcare professionals and their patients of the potential risks. This is particularly significant due to the prevailing perceptionthat e-cigarettes are inherently "safe".

The associations of insulin resistance, obesity, and lifestyle with the risk of developing hyperuricaemia in adolescents

BackgroundHyperuricaemia is common among obese children and adolescents, and is closely related to insulin resistance. The aim of this study was to explore the relationships between youth insulin resistance and hyperuricaemia, as well as their relationships with lifestyle factors in youths, to provide early guidance on the risk factors for hyperuricaemia in adolescents.MethodsThis study included 233 adolescents aged 10 to 20 years. Insulin resistance was evaluated via the homeostasis model assessment-insulin resistance (HOMA-IR) method. Binary logistic regression analysis was used to assess the associations of HOMA-IR with hyperuricaemia status and serum uric acid (UA) levels. The participants were subsequently divided into two groups, the noninsulin resistant group (HOMA-IR ≤ 3.2) and the insulin resistant group (HOMA-IR > 3.2), to further explore the factors that may affect the serum UA level. Finally, the predictive ability of different indicators of hyperuricaemia was evaluated via the ROC curve.ResultsBinary logistic regression analysis revealed a significant increase in the risk of developing hyperuricaemia for individuals with elevated HOMA-IR (p < 0.001) and insulin resistance (p < 0.01). Spearman’s correlation analysis revealed a significant positive linear correlation between HOMA-IR and serum UA levels (r = 0.4652, p < 0.001). Among insulin-resistant adolescents, UA levels were positively correlated with weight ratings, frequency of staying up late, and sugary beverages intake. Notably, individuals who engaged in 1–3 h of weekly exercise had the lowest UA levels. The area under the ROC curve for HOMA-IR was 0.847 (cut-off value = 2.165, p < 0.001), and the optimal prediction model included HOMA-IR, BMI z-score, and other lifestyle factors (AUC: 0.870, p < 0.001)).ConclusionHOMA-IR was identified as an independent risk factor for the development of hyperuricaemia and could be used as a sensitive indicator for the prediction its development in adolescents. In insulin-resistant adolescents with hyperuricaemia, maintaining normal weight, engaging in physical exercise for 1–3 h per week, avoiding staying up late and limiting sugary beverages intake are recommended to reduce the prevalence of hyperuricaemia among adolescents.

Understanding Insulin Resistance in NAFLD: A Systematic Review and Meta-Analysis Focused on HOMA-IR in South Asians.

Non-alcoholic fatty liver disease (NAFLD), a metabolic condition, is becoming increasingly common in South Asia. While its clinical diagnosis primarily relies on sonography and altered hepatic biomarkers, the significance of non-hepatic indicators, such as Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), in relation to NAFLD requires further examination in the South Asian population due to ethnic differences in these markers. This study examined the relationship between insulin resistance, quantified using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), and NAFLD, along with other non-hepatic biomarkers. A thorough literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed, Embase, and Google Scholar databases, yielding 287 articles. After applying the selection criteria and screening, 22 studies were selected for inclusion in the analysis. We extracted and meta-analyzed the data on HOMA-IR in patients with NAFLD, along with other relevant parameters. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of observational studies, whereas the RoB 2.0 tool was employed for randomized controlled trials (RCTs). The systematic review uncovered that individuals with NAFLD demonstrated statistically significant elevations in HOMA-IR levels, with a weighted mean difference (WMD) of 1.28 (95% confidence interval (CI): 1.00-1.58, I² = 98%, p < 0.0001) when compared to healthy subjects. Additionally, NAFLD patients showed markedly higher fasting blood glucose (FBG) levels, with a combined mean difference of 15.64 mg/dL (95% CI: 11.03-20.25, I² = 92%, p < 0.0001). The analysis also revealed increased triglyceride levels in NAFLD patients, with a pooled mean difference of 42.49 mg/dL (95% CI: 29.07-55.91, I² = 97%, p < 0.0001), and elevated C-reactive protein (CRP) levels, with a pooled mean difference of 2.17 mg/L (95% CI: 2.01-2.33, I² = 23%, p < 0.0001). Interestingly, subgroup analysis indicated that obese NAFLD patients exhibited significantly higher HOMA-IR levels than their non-obese counterparts, with a weighted mean difference of 5.85 (95% CI: 4.88-6.81, I² = 0%, p < 0.0001). Variations in study methodology, diagnostic techniques, and subject demographics were identified as sources of heterogeneity. The analysis found little evidence of publication bias, which lends credibility to the results. In South Asian populations, higher HOMA-IR, triglyceride-glucose (TyG) index, and CRP levels are associated with an increased risk of NAFLD. To improve the understanding and treatment of NAFLD in this specific demographic group, it is necessary to establish uniform diagnostic criteria and conduct additional studies, particularly RCTs.

Patients with chronic liver diseases are at risk for diabetes even before development of cirrhosis

Background and aimsThe prevalence of insulin resistance (IR) and type 2 diabetes mellitus (T2DM) is higher in patients with cirrhosis, compared to control patients without liver disease. The exact mechanism for this is unknown but could include liver inflammation. In this study we investigate whether cirrhosis is the primum movens of IR or if impaired insulin sensitivity is already present in non-cirrhotic patients with chronic liver diseases. MethodsPatients were recruited and divided into three groups: control (CTL), chronic liver disease without cirrhosis (CLD) and cirrhosis (CIR). In patients not taking pharmacological treatment for T2DM, IR was quantified using the homeostasis model assessment of insulin resistance (HOMA-IR). The proportion of patients with T2DM as well as HOMA-IR levels among different disease etiologies were recorded and compared. Results532 patients were included in our study. Median glycemia and insulinemia and therefore HOMA-IR values were significantly different between the three cohorts (p-value <0.001): IR levels in CLD subjects lie between those seen in CTL and CIR subjects. The proportion of diabetic patients in the two case categories also differs (p-value = 0.027): one quarter of CLD subjects and one third of CIR patients suffer from T2DM. Finally, HOMA-IR levels vary according to disease etiology (p-value <0.001): metabolic steatosis and chronic viral hepatitis C are at greater risk than alcohol and other disease causes. ConclusionCLD is already a predisposing factor to T2DM, regardless of the presence of CIR. CIR is a factor which elicits additional increase in insulin levels. Metabolic steatosis and hepatitis C are associated with more severe IR.

Associations of insulin sensitivity and immune inflammatory responses with child blood lead (Pb) and PM2.5 exposure at an e-waste recycling area during the COVID-19 lockdown.

Fine particular matter (PM2.5) and lead (Pb) exposure can induce insulin resistance, elevating the likelihood of diabetes onset. Nonetheless, the underlying mechanism remains ambiguous. Consequently, we assessed the association of PM2.5 and Pb exposure with insulin resistance and inflammation biomarkers in children. A total of 235 children aged 3-7years in a kindergarten in e-waste recycling areas were enrolled before and during the Corona Virus Disease 2019 (COVID-19) lockdown. Daily PM2.5 data was collected and used to calculate the individual PM2.5 daily exposure dose (DED-PM2.5). Concentrations of whole blood Pb, fasting blood glucose, serum insulin, and high mobility group box 1 (HMGB1) in serum were measured. Compared with that before COVID-19, the COVID-19 lockdown group had lower DED-PM2.5 and blood Pb, higher serum HMGB1, and lower blood glucose and homeostasis model assessment of insulin resistance (HOMA-IR) index. Decreased DED-PM2.5 and blood Pb levels were linked to decreased levels of fasting blood glucose and increased serum HMGB1 in all children. Increased serum HMGB1 levels were linked to reduced levels of blood glucose and HOMA-IR. Due to the implementation of COVID-19 prevention and control measures, e-waste dismantling activities and exposure levels of PM2.5 and Pb declined, which probably reduced the association of PM2.5 and Pb on insulin sensitivity and diabetes risk, but a high level of risk of chronic low-grade inflammation remained. Our findings add new evidence for the associations among PM2.5 and Pb exposure, systemic inflammation and insulin resistance, which could be a possible explanation for diabetes related to environmental exposure.

Joint association of weight-adjusted-waist index and physical activity with insulin resistance in adolescents: a cross-sectional study

BackgroundThe weight-adjusted waist index (WWI) is a recently developed obesity metric, and the aim of this study was to investigate the relationship between physical activity (PA) and WWI and the homeostasis model assessment of insulin resistance (HOMA-IR) in adolescents, as well as the joint association of HOMA-IR.MethodsThis study was based on the National Health and Nutrition Survey conducted between 2013 and 2016 and included 1024 adolescents whose median age was 15.4. Multivariate linear regression was used to examine the associations between HOMA-IR and PA and WWI. Using generalized additive models, a potential nonlinear link between WWI and HOMA-IR was evaluated. Subgroup analysis was also carried out.ResultsThe fully adjusted model revealed a positive association (β: 0.48, 95% CI: 0.43, 0.53) between the WWI and HOMA-IR. The HOMA-IR was lower in physically active (β: -0.16, 95% CI: -0.26, -0.05) participants versus inactive participants. Participants who had higher WWI and were not physically active (β: 0.69; 95% CI: 0.56, 0.82) had the highest levels of HOMA-IR compared to participants who had lower WWI and were physically active. Subgroup analysis revealed that these correlations were similar in males and females.ConclusionOur results demonstrated that higher WWI and PA were associated with a lower HOMA-IR and that WWI and PA had a combined association with HOMA-IR. The findings of this study are informative for the preventing insulin resistance in adolescents.

Role of gastric bypass surgery in control of blood sugar in obese uncontrolled type 2 diabetic patients

Background and goalThe pandemic of the twenty-first century is diabetes. Both type 2 diabetes mellitus and obesity pose severe problems for public health. Despite significant improvements in diagnosing and managing both conditions, diabetes mellitus remains poorly controlled, and diabetic complications are more common than ever. Internists have discovered over the past 20 years that obese people with type 2 diabetes who have gastric bypass surgery to shed weight have improved glycemic control. Thus, interventional diabetology has a growing significance in patients’ ability to reverse type 2 diabetes mellitus. We want to evaluate the impact of gastric bypass on blood sugar regulation and look for potential causes.Patients and methodsBetween 2018 and 2020, a prospective interventional study was carried out. Ninety patients in total were enrolled in the trial. The two patient groups (A and B) contained 45 obese T2DM patients with a body mass index (BMI) of over 35 kg/m2. Group B received its antidiabetic medications, either oral hypoglycemic or insulin, while Group A underwent gastric bypass surgery. Each patient underwent a comprehensive history review and clinical assessment. Both groups had their HA1c and blood sugar levels measured; group A had their insulin, GLP-1, and HOMA-IR (Homeostasis Model Assessment for Insulin Resistance) levels calculated at time O and one year later.ResultsThe demographic differences between the two study groups were negligible. After a one-year follow-up, group A had significantly lower anthropometric measurement data for BMI and waist circumference (cm), lipid profile data for triglycerides, total cholesterol, and LDL levels, and systolic and diastolic blood pressure. Fasting plasma glucose and HbA1c, two metrics of glucose metabolism, significantly decreased in group A. Regarding indicators of glucose metabolism, there was a drop in fasting insulin level and HOMA-IR and an increase in GLP1 level in the gastric bypass group.ConclusionAs a result of improving all indicators, gastric bypass is an effective treatment for patients with uncontrolled T2DM. Future research that is confirmed is needed.

Instant and short-term effects of acupuncture for depression and anxiety in unstable angina pectoris patients with percutaneous coronary interventions.

Patients with unstable angina pectoris (UAP) usually present anxiety or depression during percutaneous coronary intervention (PCI). This study sought to investigate the instant and short-term effects of acupuncture for anxiety and depression in UAP patients with PCI. A total of 210 UAP patients who underwent PCI were recruited and randomly assigned (1:1:1) to acupuncture, placebo, or control groups. Enzyme-linked immunosorbent assay was used to detect the levels of fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), interleukin-6 (IL-6), high-sensitivity C-reactive protein (Hs-CRP), advanced oxidation protein products (AoPPs), and oxidized low-density lipoprotein (OX-LDL). Serial questionnaires with the Hamilton Anxiety (HAMA) scale and the Pittsburgh Sleep Quality Index were evaluated, and heart rate variability indicators were obtained. Primary end-point: low frequency/high frequency (HF) was lower in the electroacupuncture group (p = 0.014), while standard deviation of normal-to-normal intervals, average standard deviation of normal-to-normal intervals, percentage of successive intervals that differ more than 50 ms, and HF were increased with acupuncture (p = 0.018, p = 0.043, p = 0.016, and p = 0.002, respectively). Secondary end-point: significant improvements in anxiety levels (HAMA) were observed in the three groups (p < 0.001). The fasting insulin and HOMA-IR levels were similar between the control group and the acupuncture group (p = 0.285 and p = 0.165, respectively). The levels of IL-6 and AoPPs differed among the three groups (p = 0.021 and p < 0.001, respectively). However, no significant differences were found in fasting plasma glucose, fasting c-peptide, Hs-CRP, and OX-LDL levels among the three groups (p = 0.585, p = 0.611, p = 0.902, and p = 0.756, respectively). In this study, short-term acupuncture may potentially relieve clinical symptoms before PCI treatment. ClinicalTrials.gov, identifier (NCT03789344).

Platelet and white blood cell counts correlate with leptin and body mass index in Japanese adolescents

Obesity is associated with mild chronic inflammation, frequently observed along with increased platelet and white blood cell (WBC) levels in adults. We aimed to clarify the relationship between peripheral blood cell count, body mass index standard deviation score (BMI-SDS), and adipocytokine levels in obese adolescents. Participants included 31 patients with obesity (age: 13.1 ± 3.1 yr) and 28 normal-weight controls (age: 13.3 ± 1.9 yr). Obesity was defined as a percentage of overweight ≥ 20%; patients with type 2 diabetes were excluded. As sex differences were observed in blood cell counts, the analysis was performed after adjusting for sex differences. The obese group has significantly higher WBC, red blood cell, and platelet counts, as well as high serum leptin levels and Homeostasis Model Assessment of insulin resistance (HOMA-IR) scores compared with those of the control group. In all participants, BMI-SDS significantly correlated with WBC and platelet counts. Platelet count correlated with serum leptin and glucose levels, whereas WBC count correlated with serum leptin, insulin, HOMA-IR, and glucose levels. Statistical analysis showed that serum leptin level significantly influenced the platelet count and HOMA-IR score affected WBC count. Increased platelet and WBC counts in adolescents with obesity may increase the risk of thrombosis.

Gender as a threat for type 2 diabetes mellitus: Elevated fasting glucose, insulin, and HOMA-IR levels in females.

Objective: The research aimed to compare serum levels of fasting plasma glucose, 2hrpp, fasting insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), and waist-to-height ratio in individuals with a diabetic background. Study Design: Cross-sectional Observational draft. Setting: District Headquarters Hospital, Gujranwala. Period: December 22, 2020, to December 22, 2022. Material &amp; Methods: Overall, 80 healthy participants, 20-50 years old, were recruited and graded into two groups based on gender. Group A comprised males, and Group B comprised females. All participants demonstrated normal glucose tolerance centered on the oral glucose tolerance test. Results: Females exhibited significantly higher mean levels of fasting plasma glucose (p=0.01), fasting plasma insulin (p=0.004), and Homeostasis Model Assessment of Insulin Resistance (p=0.007) compared to males. Homeostasis Model Assessment of Insulin Resistance and waist-to-height ratio exhibited a positive correlation (p=0.001). Conclusion: Females with a positive family history may present an amplified threat of Type 2 Diabetes Mellitus.

Insulin resistance is associated with incident chronic kidney disease in population with normal renal function.

Insulin resistance is prevalent in chronic kidney disease and may accelerate the progression of chronic kidney disease. This study aimed to investigate whether insulin resistance is associated with the development of incident chronic kidney disease in a population with normal renal function. A total of 3,331 participants from a community-based cohort with normal renal function were prospectively analyzed. We determined the relationship of insulin resistance indices with the incident chronic kidney disease using the Cox proportional hazard model and Kaplan-Meier survival analysis. During a mean follow-up of 11.03 ± 4.22 years, incident chronic kidney disease occurred in 414 participants (12.4%). The high homeostasis model assessment-insulin resistance level group had an increased risk of incident chronic kidney disease (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.13-1.74; p = 0.002) compared to the normal group after adjustment for age, sex, history of hypertension, body mass index, total cholesterol, alcohol drinking status, smoking status, and baseline estimated glomerular filtration rate. The risk of incident chronic kidney disease also increased with the lower quantitative insulin sensitivity check index level (HR, 0.62; 95% CI, 0.41-0.92; p = 0.02) and higher leptin-adiponectin ratio level (HR, 1.23; 95% CI, 1.06-1.42; p = 0.006). Higher insulin resistance indices are associated with the incidence of chronic kidney disease. Our data suggest that increased insulin resistance may be involved in the development of incident chronic kidney disease in a population with normal renal function.

Evaluation of sestrin 2 and tribbles homolog 3 levels in obese and nonobese women with polycystic ovary syndrome.

This study was designed to evaluate the relationship of two new biomarkers [tribbles homolog 3 (TRB3) and sestrin 2 levels], which were previously associated with obesity, with metabolic parameters in obese and nonobese women with polycystic ovary syndrome (PCOS). This cross-sectional case control study was conducted between September 2017 and August 2019 in the gynecology department of a tertiary referral hospital. The values of the plasma sestrin 2, TRB3, insulin, fasting plasma glucose, lipid profile, and homeostasis model assessment of insulin resistance (HOMA-IR) were compared in 90 obese women with PCOS (BMI > 30), 90 women with nonobese PCOS (BMI < 30), and 90 control patients (BMI < 30). The mean age of the study group consisting of all PCOS patients (26.11 ± 4.64 years) and the mean age of the control group (26.3 ± 4.4 years) were statistically similar (p = 0.239). The serum sestrin 2 values of the obese PCOS group were found to be statistically significantly lower than the control and non-obese PCOS groups (p = 0.001, p = 0.0001), while the sestrin 2 values of the nonobese PCOS group were found to be statistically significantly lower than the control group (p = 0.0001). The TRB3 values of the control group were found to be statistically significantly lower than the obese and nonobese PCOS groups (p = 0.0001), while the TRB3 values of the nonobese PCOS group were found to be statistically significantly lower than the obese PCOS group (p = 0.0001). A negative correlation was observed between the sestrin 2 level and BMI (r = -0.272 p = 0.0001), insulin (r = -0.261 p = 0.0001), and HOMA-IR levels (r = -0.250 p = 0.0001). A positive correlation was observed between the TRB3 values and TG (r = 0.248 p = 0.0001), and LDL-C values (r = 0.235 p = 0.0001). According to the findings in this study, low sestrin 2 and high TRB3 levels may be related to impaired metabolic status in the obese PCOS group. Thus, it may be promising for the development of treatment of PCOS and associated metabolic disorder in the future.

Abstract 16533: Non-Invasive Insulin Resistance Evaluation Using Carotid Pressure Waveforms in Framingham Heart Study

Introduction: Insulin resistance (IR) and the resultant hyperinsulinemia not only lead to the onset of diabetes but also are shown to elevate the risk of heart failure and underlie a spectrum of cardio-metabolic pathologies in both diabetic and non-diabetes patients. Measuring IR is challenging owing to reliance on an invasive and time-consuming procedure called a glucose clamp study, which is known as the gold standard method of assessing IR. However, this method is not routinely available in most clinical settings. The Homeostasis Model Assessment of IR (HOMA-IR) is a validated tool for evaluating IR calculated based on fasting glucose and insulin concentrations obtained from fasting blood samples. Determining optimal cut-off values for HOMA-IR has been challenging since its distribution varies across different demographic characteristics and populations. Aim: This study aims to facilitate the screening of HOMA-IR by introducing a new method that utilizes a non-invasive carotid pressure waveform to assess HOMA-IR. Methods: We extracted Intrinsic Frequency Analysis-derived features from carotid pressure waveform to detect HOMA-IR using machine learning. A non-diabetic cohort from Framingham Heart Study (FHS) (n=5427, 53% female, age range 19-90) was used to develop and test the proposed method. The method was developed on 80% of the data and blindly tested on 20% . Results: Using thresholds of 0.5 and 3 for the low (carefree) and high (alarming) zones of HOMA-IR in FHS dataset, respectively, the performance of detecting high HOMA achieved an area under curve (AUC) of 0.82 on the blind test set data (n=1085) (Fig.1; ROC: receiver operating characteristic curve). Conclusion: The non-invasive nature of the proposed method facilitates the screening of metabolic disease risks based on HOMA-IR level inferences from noninvasive carotid pressure waveforms, which can be implemented in routine clinical practice using inexpensive standard hand-held tonometry devices.

Chemical Composition and Insulin-Resistance Activity of Arginine-Loaded American Cranberry (Vaccinium macrocarpon Aiton, Ericaceae) Leaf Extracts.

One of the key pathogenetic links in type 2 diabetes mellitus (T2DM) is the formation of insulin resistance (IR). Besides a wide selection of synthetic antidiabetic drugs, various plant-origin extracts are also available to support the treatment of T2DM. This study aimed to investigate and gain knowledge of the chemical composition and potential IR correction effect of American cranberry (Vaccinium macrocarpon Aiton) leaf extracts and formulate novel 3D-printed oral dosage forms for such extracts. The bioactivity and IR of L-arginine-loaded cranberry leaf extracts were studied in vivo in rats. The cranberry leaf extracts consisted of quinic, 3-caffeoylquinic (chlorogenic), p-coumaroylquinic acids, quercetin 3-O-galactoside, quercetin-3-O-glucoside, quercetin-3-xyloside, quercetin-3-O-arabino pyranoside, quercetin-3-O-arabinofuranoside, quercetin 3-O-rhamnoside, and quercetin-O-p-coumaroyl hexoside-2 identified by HPLC. In vivo studies with rats showed that the oral administration of the cranberry leaf extracts had a positive effect on insulin sensitivity coefficients under the insulin tolerance test and affected homeostasis model assessment IR levels and liver lipid content with experimental IR. A novel 3D-printed immediate-release dosage form was developed for the oral administration of cranberry leaf extracts using polyethylene oxide as a carrier gel in semi-solid extrusion 3D printing. In conclusion, American cranberry leaf extracts loaded with L-arginine could find uses in preventing health issues associated with IR.

Clinical efficacy of Huanglian Wendan decoction in treating type 2 diabetes mellitus: A systematic review and meta-analysis.

Huanglian Wendan decoction (HLWDD) is a traditional Chinese prescription, which has been used to treat type 2 diabetes mellitus (T2DM) in recent years. However, no studies have evaluated its underlying clinical efficacy. Therefore, we used systematic review and meta-analysis to explore the clinical efficacy of HLWDD in treating T2DM. The randomized controlled trials of HLWDD on T2DM were retrieved from Chinese and foreign databases. The primary outcomes included fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG), and glycosylated hemoglobin, type A1c (HbA1c). The secondary outcomes included fasting serum insulin, homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c). Statistical analyses were performed using Review Manager and Stata software. Mean difference (MD) with 95% confidence intervals (CI) were used to describe results. The grades of recommendation assessment, development and evaluation approach was used to rate the quality of the evidence; and trial sequential analysis was used to evaluate the required information size and treatment benefits. Twenty-three randomized controlled trials were included in this study. We showed that HLWDD can improve FBG (MD = -0.99, 95% CI: -1.10 to -0.88), 2hPG (MD = -1.57, 95% CI: -1.97 to -1.17), HbA1c (MD = -1.11, 95% CI: -1.42 to -0.80), HOMA-IR (MD = -0.80, 95% CI: -1.80 to -0.51), TC (MD = -0.65, 95% CI: -0.88 to -0.42), TG (MD = -0.32, 95% CI: -0.38 to -0.27), LDL-c (MD = -0.54, 95% CI: -0.66 to -0.41), and HDL-c (MD = 0.08, 95% CI: 0.02-0.15) levels in T2DM patients. Trial sequential analysis suggested that the eficacy of HLWDD in improving FBG, 2hPG, HbA1c, HOMA-IR, TC, TG, LDL-c, and HDL-c was sufficient to draw a firm conclusion. Grades of recommendation assessment showed that HLWDD only has high or moderate quality of evidence in improving FBG, and TG. HLWDD can improve blood glucose and blood lipid levels in T2DM patients, and may be a potential drug to treat T2DM.