IGR Group Research Articles

Effects of early rehabilitation on functional outcomes in patients after coronary artery bypass graft surgery: a randomized controlled trial.

ObjectiveThis study evaluated the effectiveness, feasibility, and safety of early rehabilitation for patients after coronary artery bypass graft (CABG) surgery.MethodsIn a three-arm randomized controlled trial, patients who underwent CABG from January 2018 to June 2018 were randomly assigned to one of three groups: (i) usual care (UC group); (ii) UC + single general ward rehabilitation (SGR group); and (iii) UC + general ward rehabilitation and intensive care unit (ICU) rehabilitation (IGR group). The primary outcome was the Barthel Index scores.ResultsThe Barthel Index score for UC (75.3 ± 12.1) was significantly lower than that of both SGR (86.2 ± 14.1) and IGR (89.1 ± 15.5). There was no significant difference in the Barthel Index scores between the SGR and IGR groups. Statistically significant differences were found in the length of ICU stay and post-operative hospital stay but not in post-operative pulmonary complications (PPC) or atrial fibrillation between the three groups.ConclusionEarly rehabilitation implemented during ICU stay and on the general ward resulted in significant improvements in functional independence and could be a safe part of routine care post-CABG.

DS21, a new noninvasive technology, is effective and safe for screening for prediabetes and diabetes in Chinese population

BackgroundScreening for prediabetes and asymptomatic diabetes is important for preventing development to an irreversible stage. The current diagnosis of prediabetes and diabetes is based on blood glucose or HbA1c (an invasive method). The aim of this study was to assess the efficacy and safety of DS21, a new noninvasive technology, for noninvasive screening for prediabetes and diabetes.MethodsA total of 939 subjects were divided into a normal control group (NC, n = 308), impaired glucose regulation group (IGR, n = 312), and diabetes (DM) group (n = 319). All subjects underwent the DS21 test, and mean hands–feet, hand, and feet conductance values were analyzed. The diagnostic accuracy of the conductance value was analyzed by receiver-operating characteristic (ROC) curve.ResultsThe conductance values for hands–feet, hands, and feet in the DM and IGR groups were significantly lower than those in the NC group (all P < 0.01). The area under the ROC curve (AUCROC) for distinguishing NC/IGR was highest when using hands–feet conductance values (0.766 [95% confidence interval, CI 0.730, 0.803]). However, the AUCROCs of distinguishing NC/abnormal glucose metabolism (AGM, including IGR+DM), non-diabetes (NDM)/DM, and IGR/DM were highest when using conductance values for hands at 0.782 [95% CI 0.752, 0.812], 0.688 [95% CI 0.653, 0.723] and 0.573 [95% CI 0.528, 0.617], respectively (all P < 0.01). Hand conductance of values 75.0 (sensitivity 0.769, specificity 0.660), 77.1 (sensitivity 0.718, specificity 0.695), 68.4 (sensitivity 0.726, specificity 0.555), and 58.1 (sensitivity 0.384, specificity 0.744) were recommended as the screening thresholds for NC/AGM, NC/IGR, NDM/DM, and IGR/DM, respectively. A hand conductance value 66.0 was also recommended to distinguish NC/AGM due to its high sensitivity and high PPV. No adverse events occurred in the test.ConclusionsDS21 is fast, noninvasive, low cost, reliable and safe, which makes it a feasible device for screening for prediabetes and diabetes, especially in a large population.

Relationships among pancreatic beta cell function, the Nrf2 pathway, and IRS2: a cross-sectional study

ABSTRACT Objectives This study aimed to investigate the relationships among islet function, the Nrf2 pathway, and insulin receptor substrate 2 (IRS2) in type 2 diabetes mellitus (T2DM), prediabetes mellitus (IGR), and normal glucose tolerance (NGT) populations. Methods Three hundred cases each were selected for the NGT, IGR, and T2DM groups; FBG, 2hPG, HbA1 c, FINS, TG, TC, HDL-C, and LDL-C levels and serum levels of nuclear factor in E2-related factor 2 (Nrf2), insulin receptor substrate 2 (IRS2), tumor necrosis factor alpha (TNF-α), and heme oxygenase 1 (HO-1) were evaluated. Results The T2DM group had lower islet β-cell function index and insulin sensitivity index than the NGT and IGR groups (P < 0.05). The Nrf2, IRS2, and HO-1 levels in the NGT, IGR, and T2DM groups followed a decreasing trend in the order mentioned, whereas the TNF-α levels followed an increasing trend. Conclusions Upon impairment of glucose regulation, the expression of TNF-α in the human body increased, which indicated the aggravation of oxidative stress (OS) and the inflammatory response. Islet function was maintained in the pre-diabetic population, and concurrently, the TNF-α, Nrf2, and HO-1 levels were moderately elevated, the expression of IRS2 was marginally inhibited, and the Nrf2 pathway was activated under mild OS stimulus to resist OS, inflammation, and injury, which may have been mediated through PI3 K/AKT. In patients with T2DM, islet function was significantly poorer, TNF-α amplification was enhanced significantly, and Nrf2, HO-1, and IRS2 expression reduced significantly; this suggested that, along with the aggravation of OS and the inflammatory response, Nrf2 pathway activation and HO-1 expression were both inhibited, the antioxidant capacity of the body was reduced, IRS2 degradation increased, and islet function was impaired.

The dawn phenomenon across the glycemic continuum: Implications for defining dysglycemia

AimsTo investigate the frequency of dawn phenomenon (DP) and its relationship with time in range (TIR) and glycemic variability (GV) using continuous glucose monitoring (CGM). Methods781 subjects of a multicenter CGM study in China were included: those with normal glucose tolerance (NGT n = 360); impaired glucose regulation (IGR n = 173); newly diagnosed type 2 diabetes mellitus (T2D n = 248). Analysis of the magnitude of DP (ΔG) was conducted with the primary definition of 1.11 mmol/L and a secondary definition of 0.56 mmol/L. ResultsThe frequency of DP was 8.9%, 30.1% and 52.4% in NGT, IGR and T2D group, respectively, using the primary definition. In all three groups, TIR was lower (all P < 0.05), coefficient of variation (CV) was higher in DP subgroup (all P < 0.05). In DP subgroup of T2D, TIR was 7.0% (1.68 h) lower and CV was 3.0% higher, and HbA1c was 0.6% (7 mmol/mol) higher using the primary definition (all P < 0.05). ConclusionsDP was present in a high percent of subjects with NGT and IGR. In newly diagnosed T2D group, the presence of DP was associated with poorer overall glycemic control.

Mindfulness-Based Student Training Leads to a Reduction in Physiological Evaluated Stress.

Background and ObjectiveIn today’s fast-paced modern lifestyle, chronic stress has become a serious issue with potential consequences for our physical and mental health. The concept of mindfulness and its derived Mindfulness-Based Stress Reduction (MBSR) program is considered to be an effective stress management technique for patients as well as for healthy persons. The effects of MBSR interventions on their participants have been subject of previous research, especially with regard to psychological or social science approaches using self-reports and questionnaires. In contrast, medical investigations in this field have been less frequent and often somehow limited, for example, addressing only absolute (discrete) mean values for heart rate or blood pressure.MethodsIn this study, we have evaluated a Mindfulness Based Student Training program (MBST) by applying methods of biosignal analysis to examine its impact on the training participants’ autonomic regulation. This intervention program included classical MBSR elements but was adapted to suit the normal daily needs of university students. We obtained the electrocardiogram, finger-pulse plethysmography, and respiration activity from students participating in either the intervention group (IGR, 38 subjects) or a passive control group (CON, 35 subjects) prior to and after 8 weeks of MBST intervention.ResultsWhen comparing various indices from heart rate variability, pulse wave variability, and respiration in linear and nonlinear domains, significant changes in the autonomic regulation were observed for the IGR group after 8 weeks of MBST.ConclusionThe results indicate a reduced stress level exclusively for the intervention participants, and therefore, we assume a health benefit from the MBST program.

Effect of vitamin D intervention on the outcome of glucose metabolism in patients with impaired glucose regulation

Objective To explore the intervention effect of low-dose vitamin D on glucose metabolism of patients with impaired glucose regulation. Methods A total of 196 subjects receiving oral glucose tolerance test were enrolled in this study, including individuals with normal glucose tolerance (NGT group, n=67) and individuals with impaired glucose regulation (IGR group, n=129). The IGR group was divided into intervention group (n=64)and non-intervention group (n=65) according to vitamin D intervention (for 1 year) performed or not. Clinical data and biochemical parameters were collected. Results The level of serum 25(OH)D3 was significantly lower in the IGR group than that of normal control group (P<0.05). After 1 year of low-dose vitamin D intervention, insulin sensitivity increased and insulin resistance decreased in the intervention group as compared with non-intervention group. Diabetes developed less frequently in the intervention group (25 of 64 [39.1%]) compared with non-intervention group (30 of 65 [46.2%]). But there was no significant different in diabetes prevalence between the two groups. Conclusions Vitamin D intervention can improve insulin sensitivity and reduce insulin resistance in patients with impaired glucose regulation. Low dose vitamin D can improve the abnormal glucose metabolism outcome in patients with impaired glucose regulation. Key words: vitamin D; 25(OH)D3; type 2 diabetes mellitus; insulin secretion

Pancreatogenic diabetes mellitus – Prevalence and risk factors

The gut peptide hormone ghrelin induces appetite and exhibits an anti-inflammatory effect. Serial perioperative changes in ghrelin have been examined in several surgical procedures, but few in pancreatectomy. The present study analyzed perioperative changes in plasma ghrelin levels after pancreaduodenectomy (PD).The study included 24 patients undergoing PD between May 2015 and January 2016 at Osaka University Hospital. Plasma ghrelin and interleukin-6 (IL-6) levels, as well as white blood cells (WBCs) and C-reactive protein (CRP), were measured preoperatively and on postoperative day (POD) 1, 3, 7, and 14 by enzyme-linked immunosorbent assay. The relationship between the individual ghrelin ratio relative to preoperative value (IGR) and the development of grade IIIa-V Clavien-Dindo (CD) complications was examined.Twelve patients (50%) developed grade IIIa CD complications (n = 6 [25%] pancreatic fistula, n = 7 [29%] intraabdominal abscess, n = 3 [13%] post-pancreatectomy hemorrhage, n = 5 [21%] wound infection, and n = 1 [4%] lymphorrhea). The IGR on POD 1 was significantly lower (p = 0.014) in patients who developed the complications compared to those who did not, but no significant differences were found in terms of WBC, CRP, or IL-6 on POD 1. When the IGR cut-off was set to 82% by receiver operative curve analysis, the sensitivity was 83%, specificity 75% and area under the curve 0.80. The lower IGR group (≤82%) had more postoperative complications and longer hospital stay.The IGR on POD 1 after PD is a useful marker for predicting postoperative complications.

Circulating PCSK9 levels and 2-hPG are positively correlated in metabolic diseases in a Chinese Han population

BackgroundProprotein convertase subtilisin/kexin type 9 (PCSK9), which plays a crucial role in lipoprotein metabolism, has been also regarded as an important marker for atherosclerosis. Available evidence indicated that 2-h postchallenge plasma glucose (2-hPG) could be another biomarker for atherosclerosis. However, currently the association between circulating PCSK9 and 2-hPG remains unclear. Here, we explored this potential link in a Chinese Han population.MethodsTotally, 600 Chinese Han subjects from Nanjing district, China, were enrolled for the 75-g oral glucose tolerance test (OGTT), and they included normal glucose tolerance (NGT, n = 200), impaired glucose regulation (IGR, n = 200), and type 2 diabetes (T2DM, n = 200). Anthropometric and biochemical determinations such as serum lipid measurements were made. A sandwich ELISA assay was performed to measure serum PCSK9 levels in all subjects.ResultsSerum PCSK9 concentrations were higher in IGR group (77.63 ± 28.14 ng/ml) and T2DM group (90.62 ± 39.96 ng/ml) than in NGT group (65.33 ± 32.68 ng/ml), and it was significantly higher in T2DM group than in IGR group (p < 0.01). Serum PCSK9 levels positively correlated with 2-hPG and LDL-C in all subgroups, but presented a positive correlation with fasting blood glucose (FBG) only in T2DM group. Using multiple regression model analysis, we also found that PCSK9 levels closely correlated with 2-hPG in all tested groups. According to multinomial logistic regression analysis, PCSK9 levels positively correlated with T2DM (OR = 1.017[1.010–1.025], p < 0.001) even after adjustment for lipid levels. Moreover, in subjects with normal FBG level, 2-hPG gradually and significantly increased across PCSK9 tertiles (6.68 ± 2.01, 7.48 ± 2.10 and 8.27 ± 2.41 mmol/L, respectively, p < 0.01); however, in subjects with normal 2-hPG levels, no such difference was observed.ConclusionsPCSK9 levels increase as glucose metabolism deteriorated. Serum PCSK9 levels positively correlated with 2-hPG in patients with metabolic diseases.

Plasma ghrelin suppression as an early predictor for postoperative complications after pancreatoduodenectomy

Background/ObjectivesThe gut peptide hormone ghrelin induces appetite and exhibits an anti-inflammatory effect. Serial perioperative changes in ghrelin have been examined in several surgical procedures, but few in pancreatectomy. The present study analyzed perioperative changes in plasma ghrelin levels after pancreaduodenectomy (PD). MethodsThe study included 24 patients undergoing PD between May 2015 and January 2016 at Osaka University Hospital. Plasma ghrelin and interleukin-6 (IL-6) levels, as well as white blood cells (WBCs) and C-reactive protein (CRP), were measured preoperatively and on postoperative day (POD) 1, 3, 7, and 14 by enzyme-linked immunosorbent assay. The relationship between the individual ghrelin ratio relative to preoperative value (IGR) and the development of grade IIIa-V Clavien-Dindo (CD) complications was examined. ResultsTwelve patients (50%) developed grade IIIa CD complications (n = 6 [25%] pancreatic fistula, n = 7 [29%] intraabdominal abscess, n = 3 [13%] post-pancreatectomy hemorrhage, n = 5 [21%] wound infection, and n = 1 [4%] lymphorrhea). The IGR on POD 1 was significantly lower (p = 0.014) in patients who developed the complications compared to those who did not, but no significant differences were found in terms of WBC, CRP, or IL-6 on POD 1. When the IGR cut-off was set to 82% by receiver operative curve analysis, the sensitivity was 83%, specificity 75% and area under the curve 0.80. The lower IGR group (≤82%) had more postoperative complications and longer hospital stay. ConclusionsThe IGR on POD 1 after PD is a useful marker for predicting postoperative complications.

Association of serum fibroblast growth factor 19 levels with visceral fat accumulation is independent of glucose tolerance status

Background and aimsRecent studies suggested that circulating fibroblast growth factor (FGF) 19 levels might be associated with the fat content and distribution, and varied with different glucose tolerance status. This study aimed to investigate the association of serum FGF19 levels with obesity and visceral fat accumulation in a Chinese population with differing glucose tolerance status. Methods and ResultsThe 2383 participants were divided into subgroups of glucose tolerance status: normal glucose tolerance (NGT, n = 1754), impaired glucose regulation (IGR, n = 499), and newly diagnosed diabetes mellitus (DM, n = 130). They were further stratified into quartiles of serum FGF19 levels (Q1–Q4). Visceral fat area (VFA) and subcutaneous fat area were measured using magnetic resonance imaging. FGF19 were detected via quantitative sandwich enzyme-linked immunosorbent assay. Serum FGF19 levels showed a downtrend across the NGT, IGR, and DM groups (P for trend = 0.016). VFA was an independent and negative factor of serum FGF19 levels (standardized β = −0.108, P = 0.001). After adjustment for glucose tolerance status, VFA differed significantly among FGF19 quartiles (P < 0.001), showing a downtrend from Q1–Q4. The associations of serum FGF19 levels and glucose tolerance status with VFA were independent of each other. After adjustment for insulin resistance and secretory function separately, VFA still decreased significantly from Q1–Q4 (all P < 0.001). ConclusionSerum FGF19 levels were related to visceral fat accumulation. Independent of glucose tolerance status, serum FGF19 levels were inversely associated with VFA.

Use of First-phase Insulin Secretion in Early Diagnosis of Thyroid Diabetes and Type 2 Diabetes Mellitus.

Background:A relationship between hyperthyroidism and insulin secretion in type 2 diabetes mellitus (T2DM) has been reported. Therefore, this study explored the use of first-phase insulin secretion in the differential diagnosis of thyroid diabetes (TDM) and T2DM.Methods:In total, 101 patients with hyperthyroidism were divided into hyperthyroidism with normal glucose tolerance (TNGT), hyperthyroidism with impaired glucose regulation (TIGR), and diabetes (TDM) groups. Furthermore, 96 patients without hyperthyroidism were recruited as control groups (normal glucose tolerance [NGT], impaired glucose regulation [IGR], and T2DM). The following parameters were evaluated: homeostasis model assessment (HOMA)-IR, HOMA-β, modified β-cell function index (MBCI), peak insulin/fasting insulin (IP/I0), AUCins-OGTT, and AUCins-OGTT/AUCglu-OGTT from the oral glucose tolerance test (OGTT) insulin release test were utilized to assess the second-phase insulin secretion, while the IP/I0, AIR0′~10′, and AUCins-IVGTT from the intravenous glucose tolerance test (IVGTT) insulin release test were used to assess the first-phase insulin secretion.Results:In the OGTT, the HOMA-β values of the TNGT and TDM groups were higher than those of the NGT and T2DM groups (all P < 0.05). In the hyperthyroidism groups, the MBCI of the TDM group was lower than that of the TNGT and TIGR groups (all P < 0.05). Among the control groups, the MBCI values of the IGR and T2DM groups were lower than that of the normal glucose tolerance (NGT) group (all P < 0.05). In the IVGTT, insulin secretion peaked for all groups at 2–4 min, except for the T2DM group, which showed a low plateau and no secretion peak. The IP values of the TNGT, TIGR, and TDM groups were higher than those of the NGT, IGR, and T2DM groups (all P < 0.05). The Ip/I0, AIR0′~10′, and AUCins-IVGTT values of the TDM group were higher than those of the T2DM group but were lower than those of the TNGT, TIGR, NGR, and IGR groups (all P < 0.05). Compared with the other five groups, the Ip/I0, AIR0′~10′, and AUCins-IVGTT values of the T2DM group were significantly decreased (all P < 0.05). The Ip/I0 and AUCins-IVGTT values of the TNGT group were higher than those of the NGT group (all P < 0.05).Conclusions:β-cell function in TDM patients is superior to that in T2DM patients. First-phase insulin secretion could be used as an early diagnostic marker to differentiate TDM and T2DM.

The Imbalance of B-Lymphocyte Subsets in Subjects with Different Glucose Tolerance: Relationship with Metabolic Parameter and Disease Status.

B lymphocytes are involved in inflammation and are related to insulin resistance in obesity and type 2 diabetes (T2D). This study investigated the phenotype and frequency of B-lymphocyte subsets in subjects recently diagnosed with T2D (n = 60), impaired glucose regulation (IGR, n = 73), and normal glucose tolerance (NGT, n = 169) by flow cytometry. T2D subjects had an increased percentage of CD19+CD23+ (B-2) cells and a decreased percentage of CD19+CD23− (B-1) cells attributing to CD19+CD23−CD5− (B-1b) cells, but not CD19+CD23−CD5+ (B-1a) cells, compared to NGT and IGR subjects. The proportion of CD19+CD5+CD1dhi (B10) cells did not differ between the IGR or T2D group and NGT controls. Of note, HbA1c and triglyceride showed a positive correlation with B-2 cells but an inverse correlation with B-1 and B-1b cells, which were independently associated with the presence of T2D by logistic regression models. In summary, this study shows an unbalanced proinflammatory phenotype of B-cell subsets correlated with glycemia and lipidemia in patients with T2D. Our data provide new insight into chronic activation of the immune system and subclinical inflammation in T2D. Further prospective studies are warranted to confirm our observations.

Analysis of medication with hypertension by different glucose tolerance status

To analyze the combination of hypertension and the use of antihypertensive drugs by different glucose tolerance status. Matched case-control design was used to sample the subjects from the population for the prevalence of diabetes mellitus and metabolism syndrome from 2007 to 2008. There were 3 groups including normal glucose tolerance (NGT, n = 2124), impaired glucose regulation (IGR, n = 2162) and diabetes (DM, n = 2470). The matched factors were location, age and gender. All subjects were interviewed to describe the hypertension and antihypertensive drugs of these conditions. After adjusting for age, gender and location, the combination of hypertension in IGR and DM groups was higher than NGT (28.3%, 40.2% and 19.9%) and OR was 1.29 (1.08 - 1.53) and 1.99 (1.67 - 2.37) respectively. The percent of treatment, prescription compliance and the surveillance of hypertension in total subjects were 48.6%, 79.3% and 62.5%. And no difference was observed among 3 groups. The proportion of calcium channel blocker of DM groups was higher than NGT group. The uses of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blocker (ARB) showed no difference among 3 groups. The combination of hypertension is higher in IGR and DM groups than that in NGT group. And the treatment rate of hypertension remains low. ACEI and ARB are under-utilized in IGR and DM groups.

The correlation analysis between hepatitis B induced cirrhosis glucose metabolism disorders and hepatitis B immune related indexes and the regional epidemic characteristics

Objective To investigate the correlation between hepatitis B induced cirrhosis glucose metaboliam disorders and hepatitis B immune related indexes,to analyze the epidemic characteristics in the local region.Methods 128 cases with hepatitis B induced cirrhosis were divided into the NGT group,IGR group and DM group,according to 75g oral glucose tolerance test(OGTT).Results The difference of waist size,and body mass index data in the three groups had statistically significant difference( F =22.71,24.62,all P ＜ 0.05 ).As the aggravating of glu cose metabolism disorder,the positive rate of HBsAg,HBeAg and former S1 antigen of NGT group,IGR group and DM group were gradually raised,and the differences were statistically significant ( F =17.35,21.47,19.37,all P ＜0.05).Conclusion There was positive correlation between virus infection in patients with hepatitis B induced cirrhosis and glucose metabolism disorder.There were intimate connection between the epidemiological factors such as age,waist size,weight,and body mass index and glucose metabolism disorder in patients with hepatitis B induced cirrhosis. Key words: Liver Cirrhosis; Glucose metabolism disorders; Hepatitis B surface antigen,hepatitis B; Hepatitis core antigen,hepatitis B

Investigating Endothelial Activation and Oxidative Stress in relation to Glycaemic Control in a Multiethnic Population

Aim. An exploration of ethnic differences in measures of oxidative stress and endothelial activation in relation to known cardiovascular risk factors within South Asians (SA) and White Europeans (WE) residing in the UK. Methods. 202 participants within a UK multiethnic population provided biomedical and anthropometric data. Human urinary 2,3-dinor-8-iso-prostaglandin-F1α and plasma ICAM-1 were quantified as measures of oxidative stress and endothelial activation, respectively. Results. 2,3-Dinor-8-iso-prostaglandin-F1α levels were significantly higher in the SA group compared to WE group (10.36 (95% CI: 9.09, 11.79) versus 8.46 (7.71, 9.29), P = 0.021) after adjustment for age, gender, smoking status, body weight, HbA1c, and medication. Oxidative stress was positively associated with HbA1c (β = 1.08, 95% CI:1.02, 1.14, P = 0.009), fasting (β = 1.06, 95% CI: 1.02, 1.10, P = 0.002), and 2 hr glucose (β = 1.02, 95% CI: 1.00, 1.04, P = 0.052). In each adjusted model, SA continued to have elevated levels of oxidative stress compared to WE. ICAM-1 levels were significantly higher in the composite IGR group compared to the normoglycaemic group (P < 0.001). No ethnic differences in ICAM-1 were observed. Conclusion. These results suggest that SA are more susceptible to the detrimental effects of hyperglycaemia-induced oxidative stress at lower blood glucose thresholds than WE. Further research into the potential mechanisms involved is warranted.

Interaction between Cholesteryl Ester Transfer Protein and Hepatic Lipase Encoding Genes and the Risk of Type 2 Diabetes: Results from the Telde Study

Background and AimDiabetic dyslipidaemia is common in type 2 diabetes (T2D) and insulin resistance and often precedes the onset of T2D. The Taq1B polymorphism in CETP (B1 and B2 alleles) (rs708272) and the G-250A polymorphism in LIPC (rs2070895) are associated with changes in enzyme activity and lipid concentrations. Our aim was to assess the effects of both polymorphisms on the risk of T2D.Methods and ResultsIn a case-control study from the population-based Telde cohort, both polymorphisms were analysed by PCR-based methods. Subjects were classified, according to an oral glucose tolerance test, into diabetic (N = 115) and pre-diabetic (N = 116); 226 subjects with normal glucose tolerance, matched for age and gender, were included as controls. Chi-square (comparison between groups) and logistic regression (identification of independent effects) were used for analysis. The B1B1 Taq1B CETP genotype frequency increased with worsening glucose metabolism (42.5%, 46.1% and 54.3% in control, IGR and diabetic group; p = 0.042). This polymorphism was independently associated with an increased risk of diabetes (OR: 1.828; IC 95%: 1.12–2.99; p = 0.016), even after adjusting by confounding variables, whereas the LIPC polymorphism was not. Regarding the interaction between both polymorphisms, in the B1B1 genotype carriers, the absence of the minor (A) allele of the LIPC polymorphism increased the risk of having diabetes.ConclusionThe presence of the B1B1 Taq1B CETP genotype contributes to the presence of diabetes, independently of age, sex, BMI and waist. However, among carriers of B1B1, the presence of GG genotype of the -250 LIPC polymorphism increases this risk further.

Function of islet β cell and metabolic features in gout patients with different status of glucose metabolism

Objective To investigate the changes of insulin resistance and islet β cell function in gout patients with different status of glucose metabolism, and to analyse metabolic features in gout patients with hyperglycemia. Methods Ninety-six patients with gout were consecutively enrolled into the study and were divided into normal glucose tolerance group ( NGT, n = 35 ) , impaired glucose regulation group ( IGR, n = 27 ) , and diabetic group (DM, n=34). Height, weight, blood pressure, fasting plasma glucose, fasting insulin, HbA1C,serum uric acid, C-reactive protein (CRP), total cholesterol (TC), and triglycerides were determined in all subjects. Body mass index (BMI), homeostasis model assessment for insulin resistance index (HOMA-IR),homeostasis model assessment for β cell function index (HOMA-B), and insulin sensitivity index (ISI) were calculated. Results Compared with the NGT group, the levels of BMI, 2hPG, fasting insulin, HbA1C,TC,triglycerides, CRP, HOMA-IR in the DM and IGR groups were higher while ISI was lower (0.023±0.018 and 0.024±0.017 vs 0. 052±0. 026, P<0.05 ). HOMA-B was significantly different among the three groups ( 87.6±25. 1,126.46±34. 2, and 173.75±32.1, P<0.05). Family history of diabetes was more commonly seen in DM group than NGT group ( 41.17% vs 11.4%, P< 0.05 ). Logistic analysis showed that age, BMI, systolic blood pres(s)ure, triglyceride, CRP, and ISI were independently associated with diabetes, but not with uric acid.Conclusions Severe insulin resistance, β cell dysfunction, increased BMI and CRP, lipid disorders, and hereditary susceptibility may be the main metabolic features of gout patients with hyperglycemia. Key words: Gout; Insulin resistance; β cell function; Glucose metabolism; C-reactive protein

Relationship between adiponectin and the first phase of glucose-stimulated insulin secretion from pancreatic β-cell in patients with type 2 diabetes mellitus

Objective To investigate the relationship between adiponectin and the first-phase of pancreatic P-cell insulin secretion in subjects with different statuses of glucose tolerance. Methods Thirty-seven patients with newly diagnosed type 2 diabetes mellitus (DM) , 30 patients with abnormal glucose tolerance (IGR) , and 40 normal control subjects (NGT) underwent intravenous glucose tolerance test (IVGTT). Fasting adiponectin and proinsulin (PI) was assayed by EL1SA. Fasting free fatty acid ( FFA) was measured by colorimetry. Insulin area under the curve ( AUC ) , incremental AUC (iAUC) from 0 min to 10 min, AIR3-5, homeostasis model assessment for insnlin resistance (HOMA-IR) , and for β cell function ( HOMA-p) were calculated. The relationship between adiponectin and AUC, iAUC, AIR3-5, proinsulin, FFA, and HOMA-IR was explored. Results (1) The levels of AUC, iAUC, AIR3-5, and adiponectin in DM group and IGR group were significantly lower than those in NGT group (P<0.05), reduced in DM group than those in IGR group(P<0.05). (2) The levels of PI in DM group and IGR group were significantly higher than that in NGT (P<0.05). (3) Adiponectin was positively correlated with HOMA-p,AUC,iAUC,AIR3-5, and HDL-C,while negatively correlated with proinsulin, HOMA-IR, and LDL-C. (4) Proinsulin was positively correlated with HOMA-IR. (5 ) Multiple regression stepwise analysis showed that adiponectin was independently associated with AUC. Conclusions Adiponectin was an independent factor affecting the first phase of pancreatic p-cell insulin secretion. Low adiponectin level could predict the dysfunction of the first phase pancreatic p-cell secretion as well as insulin resistance in patients with type 2 diabetes. Key words: Adiponectin; Intravenous glucose tolerance test; First-phase of insulin secretion; Proinsulin

Relationship between serum high-sensitivity C-reactive protein and obesity and impaired glycose metabolism in children and adolescents

High-sensitivity C-reactive protein (hs-CRP) may predict the development of type 2 diabetes mellitus (T2DM), metabolic syndrome (MS) and cardiovascular diseases (CVD) in adult, but few reports on relevant studies in children are available. The present study aimed to understand possible correlation between serum hs-CRP levels and some factors of obese children and adolescents with or without impaired glycometabolism. Seventy obese children and adolescents (age 8 - 17 years) and 30 non-obese healthy controls (group 1, 20 boys and 10 girls, mean age 12.6 years) were enrolled into this study. The obese individuals were subdivided into two groups according to the results of oral glucose tolerance test: the obese subjects without IGR (group 2, 54 cases, 43 boys and 11 girls, mean age 11.3 years) and the obese subjects with impaired glycometabolism (group 3, 16 cases, 8 boys and 8 girls, mean age 12.8 years). The levels of serum parameters including hs-CRP, glucose, lipid, insulin, C-peptide and whole blood HbA1c were determined. SPSS 10.0 was used for statistical analysis. (1) There was significant increase of serum hs-CRP level in obese children and adolescents, the median was 2.44 (0.01 - 14.6) mg/L; the level of control group was 0.1 (0.01 - 2.1) mg/L. (2) Some of the following parameters, such as fasting plasma glucose (FPG), triglyceride (TG), fasting insulin (FINS), C-peptide (Cp) and insulin resistance index (IRI), were found increased in group 2 and 3 as compared to group 1. When FPG and TG were still in normal range in group 2, the levels of hs-CRP and IRI were significantly higher than those in group 1, the level of hs-CRP was 2.4 (0.01 - 9.0) mg/L. While FPG and TG were abnormal in group 3, the level of hs-CRP was 2.6 (0.1 - 14.6) mg/L, but the difference had no statistical significance. (3) Pearson correlation analysis showed that there was a moderate correlation between serum hs-CRP and BMI (r = 0.414, P = 0.000). There was a low correlation between hs-CRP and waist circumference, hip circumference and waist to hip ratio (WHR). The correlation of serum hs-CRP with blood pressure, TG, cholesterol, high density lipoprotein-cholesterol (HDL-C), HbA1c, FPG, FINS and Cp had no significant deviation. (4) Multiple linear regression analysis showed that body mass index (BMI) was the only indicator which had correlation with hs-CRP. (1) There may be a chronic low-grade inflammation and insulin resistance in obese children. (2) The level of hs-CRP might be independently correlated with BMI in children. (3) Hs-CRP and IRI elevated before FPG and TG did, which may suggest that the low-grade inflammation and insulin resistance may be a pathogenic base of DM rather than the outcome of it. (4) The elevation of hs-CRP may help predict impaired glucose and lipid metabolism.