Mean Fasting Plasma Glucose Concentration Research Articles

A Multicenter, Open-Label, Single-Arm Trial of the Efficacy and Safety of Empagliflozin Treatment for Refractory Diabetes Mellitus with Insulin Resistance (EMPIRE-01).

Insulin resistance syndrome and lipoatrophic diabetes are characterized by severe insulin resistance and are often refractory to treatment. Trials assessing the efficacy of antidiabetes drugs for these rare conditions have been limited, however. Sodium-glucose cotransporter2 (SGLT2) inhibitors, which lower glycemia independently of insulin action, have shown efficacy for type2 diabetes with insulin resistance. We here investigated the efficacy and safety of the SGLT2 inhibitor empagliflozin for treatment of insulin resistance syndrome and lipoatrophic diabetes. The trial was conducted at five academic centers in Japan and included seven patients with insulin resistance syndrome and one patient with lipoatrophic diabetes. Participants received 10mg of empagliflozin daily. If the hemoglobinA1c (HbA1c) level was ≥ 7.0% (52mmol/mol) after 12weeks, the dose was adjusted to 25mg. The study duration was 24weeks, and the primary outcome was the change in HbA1c level by the end of the treatment period. Safety evaluations were performed for all participants. By the end of the 24-week treatment period, the mean HbA1c level for all eight patients had decreased by 0.99 percentage points (10.8mmol/mol) (95% confidence interval [CI], 0.59 to 1.38 percentage points, 6.6 to 14.9mmol/mol) and the mean fasting plasma glucose concentration had declined by 63.9mg/dL (3.55mmol/L) (95%CI 25.5 to 102.3mg/dL, 1.42 to 5.68mmol/L). Continuous glucose monitoring revealed a reduction in mean glucose levels from 164.3 ± 76.1 to 137.6 ± 46.6mg/dL (9.13 ± 4.23 to 7.65 ± 2.59mmol/L) as well as an increase in the time in range (70-180mg/dL) from 58.9 ± 36.1% to 70.8 ± 18.3%. Seventeen mild adverse events were recorded in five individuals throughout the study period. No severe events were reported. The mean body mass showed a slight decrease and the mean serum ketone body concentration showed a slight increase during treatment. Our results demonstrate that empagliflozin shows a certain level of efficacy and safety for treatment of insulin resistance syndrome and lipoatrophic diabetes. jRCTs2051190029 and NCT04018365.

Body surface area may explain sex differences in findings from the oral glucose tolerance test among subjects with normal glucose tolerance

Background and aimsCurrent guidelines on prediabetes and diabetes (T2D) recommend to regularly perform an oral glucose tolerance test (OGTT) on subjects at risk of T2D. However, it is not known why women tend to have relatively higher 2-h post-load plasma (2hPG) glucose concentrations during OGTT than men. The aim of the present study is to investigate if there are sex differences in fasting plasma glucose (FPG) and 2hPG concentrations in relation to body size in apparently healthy non-diabetic subjects with normal glucose tolerance. We hypothesized that sex differences in glucose tolerance are physiological and related to different body surface area (BSA) in men and women. Methods and resultsA 2-h 75 g OGTT was performed on 2010 subjects aged 45–70 years. Their BSA was calculated using the Mosteller formula. Men and women were separately divided into five BSA levels. Within the normal 2hPG range, women had higher mean 2hPG concentrations during the OGTT than men in all BSA levels estimated by sex-standardized BSA (p for linearity < 0.001). BSA adjusted for age, waist circumference, leisure-time physical activity, and smoking, showed an inverse association with 2hPG concentration in both sexes. Mean FPG concentrations were higher in men than in women. ConclusionsBody size has a negative inverse association with 2hPG concentration in an OGTT even within a physiological plasma glucose range. This may cause underestimation of glucose disorders in individuals with larger BSA and overestimation in individuals with smaller BSA when using an OGTT.

Effect of Sample Volume Variation and Delay in Analysis on Plasma Glucose Concentration in Sri Lankan Healthy Adults.

The correct volume of sample and time of storing prior to the analysis are important considerations in the estimation of plasma glucose concentration of patients. The present study was to determine the effect of sample volume variation and time delay in the analysis of plasma glucose results in healthy adults. A total of 30 individuals aged between 20 and 30 years were selected for the study. Blood samples were collected into three fluoride-oxalate collection tubes separately. The results revealed that the sample volume variation from 2.0 mL fluoride-oxalate tube to 1.0 mL and 3.0 mL did not significantly affect the plasma glucose concentration (p > 0.05). However, the plasma glucose concentration in the sample significantly decreased upon delaying the analysis. The mean fasting plasma glucose concentration of analysis after one hour of collection and analysis after three hours of collection was not significantly different (p > 0.05). The mean fasting plasma glucose concentrations between one hour and five hours timepoints after collection (p < 0.001) and between three hours and five hours after collection (p = 0.014) were significantly different. In conclusion, overfilling and underfilling (2.0 ± 1.0 mL) of fluoride-oxalate tubes did not affect the plasma glucose results significantly. If the samples are analyzed within three hours of collection, the time dependent change too is not statistically significant.

Prevalence of prediabetes and type 2 diabetes in two non-random populations aged 44–77 years in the Faroe Islands

AimsThe prevalence of type 2 diabetes is increasing worldwide but little known about the status in the Faroe Islands. The aim was therefore to determine the prevalence of type 2 diabetes mellitus and prediabetes in two non-random populations aged 44–77 years. MethodsThis cross-sectional survey was conducted between 2011 and 2012 and included two sub-populations, namely 518 Septuagenarians aged 74–77 years (84% of the invited) and 401 Mark aged 44–73 years (87% of the invited). Subjects were screened for glycosylated haemoglobin, type A1c, non-fasting random plasma glucose, fasting plasma glucose followed by an oral glucose tolerance test. The screening was based on a diagnostic algorithm that included screening, diagnostic and confirmatory steps. ResultsEach group was analysed separately. In the Septuagenarian group 20.4% had type 2 diabetes, with 5.2% being newly detected and a total of 59% had prediabetes. In the Mark group 4.1% had diabetes, with 2.1% being newly detected and 22.3% had prediabetes. Diabetes increased with age and was significantly more prevalent among men. Women had lower mean fasting plasma glucose concentrations and men had lower values for 2-hours plasma glucose. Significant predictors associated with diabetes mellitus included obesity (BMI ≥ 30, abnormal waist/hip ratio and vegetable consumption. ConclusionsAmong the Faroese populations studied, the prevalence of type 2 diabetes increased with age and was more prevalent among men. The detected prevalence was comparable to other Nordic countries for all age-groups.

Efficacy and safety of oral basal insulin versus subcutaneous insulin glargine in type 2 diabetes: a randomised, double-blind, phase 2 trial

Oral insulin 338 (I338) is a long-acting, basal insulin analogue formulated in a tablet with the absorption-enhancer sodium caprate. We investigated the efficacy and safety of I338 versus subcutaneous insulin glargine (IGlar) in patients with type 2 diabetes. This was a phase 2, 8-week, randomised, double-blind, double-dummy, active-controlled, parallel trial completed at two research institutes in Germany. Insulin-naive adult patients with type 2 diabetes, inadequately controlled on metformin monotherapy or combined with other oral antidiabetic drugs (HbA1c 7·0-10·0%; BMI 25·0-40·0 kg/m2), were randomly assigned (1:1) to receive once-daily I338 plus subcutaneous placebo (I338 group) or once-daily IGlar plus oral placebo (IGlar group). Randomisation occurred by interactive web response system stratified by baseline treatment with oral antidiabetic drugs. Patients and investigators were masked to treatment assignment. Weekly insulin dose titration aimed to achieve a self-measured fasting plasma glucose (FPG) concentration of 4·4-7·0 mmol/L. The recommended daily starting doses were 2700 nmol I338 or 10 U IGlar, and maximum allowed doses throughout the trial were 16 200 nmol I338 or 60 U IGlar. The primary endpoint was treatment difference in FPG concentration at 8 weeks for all randomly assigned patients receiving at least one dose of trial product (ie, the full analysis set). The trial has been completed and is registered at ClinicalTrials.gov, number NCT02470039. Between June 1, 2015, and Oct 19, 2015, 82 patients were screened for eligibility and 50 patients were randomly assigned to the I338 group (n=25) or the IGlar group (n=25). Mean FPG concentration at baseline was 9·7 (SD 2·8) in the I338 group and 9·1 (1·7) in the IGlar group. Least square mean FPG concentration at 8 weeks was 7·1 mmol/L (95% CI 6·4-7·8) in the I338 group and 6·8 mmol/L (6·5-7·1) in the IGlar group, with no significant treatment difference (0·3 mmol/L [-0·5 to 1·1]; p=0·46). I338 and IGlar were well tolerated by patients. Adverse events were reported in 15 (60%) patients in the I338 group and 17 (68%) patients in the IGlar group. The most common adverse events were diarrhoea (three [12%] patients in each group) and nasopharyngitis (five [20%] in the I338 group and two [8%] in the IGlar group). Most adverse events were graded mild (47 of 68 events), and no severe adverse events were reported. One patient in the IGlar group had a treatment-emergent serious adverse event (urogenital haemorrhage of moderate intensity, assessed by the investigator as unlikely to be related to treatment; the patient recovered). Incidence of hypoglycaemia was low in both groups (n=7 events in the I338 group; n=11 in the IGlar group), with no severe episodes. I338 can safely improve glycaemic control in insulin-naive patients with type 2 diabetes with no evidence of a difference compared with insulin glargine, a widely used subcutaneously administered basal insulin. Further development of this particular oral insulin project was discontinued because I338 doses were high and, therefore, production of the required quantities of I338 for wide public use was deemed not commercially viable. Improvement of technologies involved in the product's development is the focus of ongoing research. Novo Nordisk.

Prevalence and risk factors of impaired fasting glucose and diabetes among Chinese children and adolescents: a national observational study.

The prevalence of impaired fasting glucose (IFG) and diabetes mellitus (DM) has reportedly increased significantly among Chinese children and adolescents. We aimed to examine the prevalence of IFG and DM, the disparities in sex and region and related risk factors among Chinese children and adolescents. A total of 16 434 Chinese children aged 6-17 years were selected from a national cross-sectional survey, and fasting glucose was measured for all participants. Overall, mean fasting plasma glucose (FPG) concentration was (4·64 (sd 0·51)) mmol/l, and the prevalence of DM and IFG was 0·10 and 1·89 %, respectively. Compared with girls, boys had higher FPG concentration (4·69 v. 4·58 mmol/l, r 0·107, P<0·001) and IFG prevalence (2·67 v. 1·07 %, r φ 0·059, P<0·001). Compared with rural children and adolescents, urban children and adolescent had higher FPG concentration (4·65 v. 4·62 mmol/l, r 0·029, P<0·001) and DM prevalence (0·15 v. 0·05 %, r φ 0·016, P<0·01). In addition, self-reported fried foods intake and overweight/obesity were positively associated with IFG, and the proportion of consuming fried foods more than or equal to once per week and overweight/obesity prevalence in boys and urban children and adolescents were significantly higher than girls and rural children and adolescents, respectively (P<0·05). Although the prevalence of IFG and DM was relatively low in Chinese children and adolescents, sex and region disparities were observed, which may be associated with differences in overweight/obesity prevalence and dietary factors.

Prevalence of type 2 diabetes and prediabetes in the Faroe Islands

AimsTo determine the prevalence of type 2 diabetes mellitus and prediabetes among the population aged 40–74 years in the Faroe Islands. MethodsThis population-based cross-sectional survey, conducted between 2011 and 2012, invited 2186 randomly selected individuals (corresponding to 11.1% of the entire population aged 40–74 years). Subjects were screened using finger capillary blood for glycosylated hemoglobin, type A1c, non-fasting random plasma glucose, fasting plasma glucose followed by oral glucose tolerance test. The test was based on an algorithm that accounts for screening, diagnostic and confirmatory steps. Anthropometric measures and a questionnaire including medical history, medication, hereditary conditions, and food intake were included. ResultsThe study included 1772 participants. Of the 1772, 169 (9.5%) had type 2 diabetes mellitus (3.0% of which were diagnosed upon study inclusion), thus 31.4% of subjects with diabetes were undiagnosed at the time of examination. A total of 271 (15.3%) had prediabetes. Diabetes was more prevalent among men, significantly from age ≥60 years. Women had lower mean fasting plasma glucose concentrations and men had lower values for 2-h plasma glucose. Predictors associated with diabetes mellitus included obesity (BMI ≥ 30), abnormal waist/hip ratio, history of hypertension or cardiovascular attack and family history of diabetes mellitus and leisure activity. ConclusionsThe prevalences of diabetes and prediabetes increased with age and were more frequent among men. The detected prevalence in the Faroe Islands was slightly higher than other Nordic countries.

Pattern of dysglycemia among Nigerian adult patients with vitiligo: a 10-year retrospective study

Background: The prevalence of dysglycemia among adult patients with vitiligo is higher than the general population. However, data is scarce in our region regarding this hypothesis. This study was to define the pattern of dysglycemia in adult Nigerian patients with vitiligo.Methods: The study was conducted retrospectively among vitiligo patients who visited the University of Port Harcourt Teaching Hospital between 1st January 2007 and 31st December 2016. The laboratory characteristics of this patients were evaluated. Data collected irrespective of vitiligo variant were age, sex, and fasting plasma glucose concentrations. Shapiro-Wilk test, descriptive statistics, chi-square test, Fisher’s exact test, and two-sample t-test were used for analysis. The level of p &lt; 0.05 was considered statistically significant.Results: There were a total of 160 vitiligo patients consisting of 55 (34.4%) males and 105 (65.6%) females. The overall patients mean age was 35±1.9 years (range 19 -61 years). The mean fasting plasma glucose concentration was 5.3±1.1mmol/l. Impaired fasting plasma glucose was detected in 41(26.6%) subjects with female dominance (female 61.0% versus male 39.0%). Diabetes mellitus was documented in 6 (3.8%) subjects with no sex difference (female 50% versus male 50%).Conclusions: Dysglycemia is frequent in vitiligo patients. Screening for dysglycemia should be incorporated into the management protocol of patients with vitiligo.

Is there sufficient evidence for a causal association between antiretroviral therapy and diabetes in HIV-infected patients? A meta-analysis.

The association of antiretroviral therapy (ART) with diabetes is inconsistent and varies widely across primary epidemiological studies. A comprehensive and more precise estimate of this association is fundamental to establishing a plausible causal link between ART and diabetes. We identified epidemiological studies that compared mean fasting plasma glucose (FPG) concentrations and proportions of diabetes and metabolic syndrome between HIV-infected patients naïve and exposed to ART. Mean difference in FPG concentrations and odds ratios of diabetes and metabolic syndrome were pooled using random-effects meta-analyses. Data on 20178 participants from 41 observational studies were included in the meta-analyses. Mean FPG concentrations (Pooled mean difference: 4.66mg/dL; 95% confidence interval [CI], 2.52 to 6.80; 24 studies) and the odds of diabetes (Pooled odds ratios: 3.85; 95% CI, 2.93 to 5.07; 10 studies) and metabolic syndrome (Pooled odds ratios: 1.45; 95% CI, 1.03 to 2.03; 18 studies) were significantly higher among ART-exposed patients, compared to their naïve counterparts. ART was also associated with significant increases in FPG levels in studies with mean ART duration ≥18months (Pooled mean difference: 4.97mg/dL; 95% CI, 3.10 to 6.84; 14 studies), but not in studies with mean ART duration <18months (Pooled mean difference: 4.40mg/dL, 95% CI, -0.59 to 9.38; 7 studies). ART may potentially be the single most consistent determinant of diabetes in people living with HIV worldwide. However, given the preponderance of cross-sectional studies in the meta-analysis, the association between ART and diabetes cannot be interpreted as cause and effect.

Association between Alcohol Intake and Hemoglobin A1c in the Korean Adults: The 2011-2013 Korea National Health and Nutrition Examination Survey.

BackgroundAlthough alcohol consumption is commonly encountered in clinical practice, few studies have investigated the clinical significance of alcohol intake on the use of the hemoglobin A1c (HbA1c) level.ObjectivesThis study was performed to investigate the association between alcohol intake and HbA1c level in the general population.MethodsAmong the 24,594 participants who participated in the 2011–2013 Korea National Health and Nutrition Examination Survey (KNHANES), 12,923 participants were analyzed in this study. We excluded diabetic patients currently taking antidiabetes medication. We compared the HbA1c level and proportions of patients with an HbA1c level of ≥5.7%, ≥6.1%, and ≥6.5% according to the fasting plasma glucose (FPG) concentration range and the amount of alcohol intake. The average amounts of daily alcohol intake were categorized into three groups: 0 g/day, <30 g/day, ≥30 g/day.ResultsThe mean HbA1c level was 5.65%, and the mean FPG concentration was 95.3 mg/dl. The percentages of patients with an HbA1c level of ≥5.7%, ≥6.1%, and ≥6.5% were 42.6%, 13.4%, and 4.5%, respectively. The average amount of alcohol intake was 12.3 g/day. The percentages of subjects with alcohol intake 0, <30, and ≥ 30 g/day were 16.5%, 69.7%, and 13.8%, respectively.There was a significant positive relationship between alcohol intake and FPG concentration (P < 0.001), the prevalence of impaired fasting glucose (P < 0.001), and the prevalence of diabetes (P < 0.001). However, there was no significant relationship between the alcohol intake and HbA1c level.Overall, the adjusted HbA1c levels decreased across alcohol intake (5.70% ± 0.01%, 5.66% ± 0.01%, and 5.55% ± 0.01%) after adjustment for confounding factors such as age, sex, FPG concentration, college graduation, smoking history, presence of hypertension, waist circumference, serum total cholesterol concentration, serum high-density lipoprotein cholesterol concentration, serum triglyceride concentration, presence of anemia, serum white blood cell count, and serum alanine aminotransferase concentration (P < 0.001). The adjusted proportions (%) of patients with an HbA1c level of ≥5.7% (P < 0.001), ≥6.1% (P < 0.001), and ≥6.5% (P < 0.001) showed significant negative trends across alcohol intake after adjustment for confounders. Logistic regression analyses showed that, when using the group that abstained as the control, the group that consumed ≥ 30g/day was negatively associated with the risk of an HbA1c level of ≥5.7% (P < 0.001), ≥6.1% (P < 0.001), and ≥6.5% (P < 0.001), using the above-mentioned variables as covariates.ConclusionsHigher alcohol intake was associated with lower HbA1c levels, even after adjusting for confounding factors, including the FPG concentration, in this nationally representative sample of Korean adults. These results suggest that excessive drinking shifts the HbA1c level downward, which might complicate use of the HbA1c level for the diagnosis of diabetes or prediabetes.

Renal Denervation for Resistant Hypertension Fails to Improve Insulin Resistance as Assessed by Hyperinsulinemic-Euglycemic Step Clamp.

We assessed whether insulin sensitivity improved after renal denervation (RDN) for resistant hypertension. Twenty-three patients underwent a two-step hyperinsulinemic-euglycemic clamp (HEC) with glucose tracer and labeled glucose infusion and oral glucose tolerance test (OGTT) before and 6 months after RDN. Eighteen patients had metabolic syndrome at baseline. Blood pressure declined significantly after RDN, whereas mean (SD) fasting plasma glucose concentration (5.9 ± 0.7 mmol/L), median (minimum-maximum) insulin concentration (254 pmol/L [88-797 pmol/L]), and median C-peptide concentration (2.4 nmol/L [0.9-5.7 nmol/L]) remained unchanged. Endogenous glucose release during HEC was less suppressed after RDN, suggesting a slight decrease in hepatic insulin sensitivity. During high-dose insulin infusion, whole-body glucose disposal was low and remained unchanged after RDN, indicating persistent peripheral insulin resistance (IR). Area under the curve for 0-120 min for glucose and insulin during OGTT, Quantitative Insulin Sensitivity Check Index, Simple Index Assessing Insulin Sensitivity Oral Glucose Tolerance, and HOMA-IR were high, and did not improve after RDN. Despite a significant decrease in blood pressure, neither peripheral nor hepatic insulin sensitivity improved 6 months after RDN treatment in this group of insulin-resistant patients without diabetes and with resistant hypertension, as measured with gold standard methods.

Effect of vildagliptin on hepatic steatosis.

Context:Although dipeptidyl-peptidase-4 inhibitors exert their major action via an incretin mechanism, a favorable effect of vildagliptin on lipid metabolism remains unexplained.Objective:The objective was to examine hepatic triglyceride levels and insulin sensitivity on vildagliptin.Design:This was a 6-month, randomized, double-blind, placebo-controlled trial.Setting:This was an outpatient study at a university clinical research center.Patients:Individuals with type 2 diabetes (n = 44) and glycated hemoglobin ≤7.6% on stable metformin therapy were included.Intervention:Intervention was vildagliptin 50 mg twice a day or placebo over 6 months.Main Outcome Measures:Main outcome measures were hepatic triglyceride levels and insulin sensitivity.Results:Mean fasting liver triglyceride content decreased by 27% with vildagliptin, from 7.3 ± 1.0% (baseline) to 5.3 ± 0.9% (endpoint). There was no change in the placebo group. The between-group difference in change from baseline was significant (P = .013). Mean fasting plasma glucose concentration decreased over the study period with vildagliptin vs placebo by −1.0 mmol/L (P = .018), and there was a positive correlation between these decrements and liver triglyceride in the vildagliptin group at 3 months (r = 0.47; P = .02) and 6 months (r = 0.44; P = .03). Plasma alanine aminotransferase fell from 27.2 ± 2.8 to 20.3 ± 1.4 IU/L in the vildagliptin group (P = .0007), and there was a correlation between the decrements in alanine aminotransferase and liver triglyceride (r = 0.83; P < .0001). Insulin sensitivity during the euglycemic clamp was similar in each group at baseline (3.24 ± 0.30 vs 3.19 ± 0.38 mg/kg/min) and did not change (adjusted mean change of 0.26 ± 0.22 vs 0.32 ± 0.22 mg/kg/min; P = .86). Mean body weight decreased by 1.6 ± 0.5 vs 0.4 ± 0.5 kg in the vildagliptin and placebo groups, respectively (P = .08).Conclusions:This study demonstrates that the dipeptidyl-peptidase-4 inhibitor vildagliptin brings about a clinically significant decrease in hepatic triglyceride levels during 6 months of therapy unrelated to change in body weight. There was no change in peripheral insulin sensitivity.

Insulin degludec as an ultralong-acting basal insulin once a day: a systematic review.

BackgroundInsulin degludec (IDeg) is a neutral, ultralong-acting new generation basal insulin analog developed by NovoNordisk currently in Phase III clinical development. IDeg offers a duration of action of more than 42 hours in adults, much longer than current basal insulin formulations.ObjectiveThe aim of this review is to assess the efficacy and safety data of IDeg in the treatment of type 1 and type 2 diabetes mellitus.MethodsRelevant English language articles from 2010 to 2012 were identified through MEDLINE, PubMed, EMBASE, Scopus, BIOSIS, and Google Scholar. Online conference proceedings of the 71st ADA Scientific Sessions and the 47th EASD Annual Meeting were reviewed. Studies were compared in terms of their study designs, primary and secondary efficacy parameters, and tolerability data.ResultsThere are a total of nine published trials investigating the clinical efficacy and safety of IDeg in over 3000 subjects with type 1 and 2 diabetes. Only three trials were published in full. All were open-label, randomized multicenter trials with durations of 16 to 52 weeks. IDeg and coformulations of IDeg with insulin aspart (IAsp) were compared to insulin glargine (IGlar), detemir, and biphasic IAsp 30 (BIAsp 30).ConclusionBased upon the available evidence, there appear to be no reported differences between IDeg and IGlar, detemir, or BIAsp 30 in the reduction of the primary efficacy end-points of HbA1c and mean fasting plasma glucose (FPG) concentrations. Only flexible dosing of IDeg provided a significant reduction in FPG compared to IGlar. IDeg demonstrated a significant reduction in nocturnal hypoglycemia in type 1 diabetes. In type 2 diabetes, IDeg reduced the incidence of hypoglycemia by 18% and 58% compared to IGlar and BIAsp 30, respectively.

Potential CYP2C9‐mediated drug–drug interactions in hospitalized type 2 diabetes mellitus patients treated with the sulphonylureas glibenclamide, glimepiride or glipizide

Sulphonylureas are widely used in the treatment of type 2 diabetes mellitus (T2DM). Based on laboratory findings, we determined the clinical significance of potential CYP2C9-mediated drug-drug interactions in hospitalized patients receiving glibenclamide, glimepiride or glipizide, all of which are metabolized by CYP2C9, together with a CYP2C9 inhibitor. An observational pharmaco-epidemiological database study was performed in a university hospital setting with 3884 patients with T2DM. Efficacy and safety of sulphonylurea therapy during the potential interaction (sulphonylurea treatment with a CYP2C9 inhibitor) vs. control periods (sulphonylurea treatment without a CYP2C9 inhibitor) were estimated using laboratory parameters. Almost 20% of patients were exposed to a potential drug-drug interaction with a CYP2C9 inhibitor during sulphonylurea treatment. More than 75% of the potential interactions occurred with trimethoprim, metronidazole and fluconazole. When all sulphonylureas were pooled and adjusted for age, gender, ward and sulphonylurea dose, mean and maximum fasting plasma glucose concentrations as well as maximum values of glycosylated haemoglobin were significantly lower during the interaction periods compared with control periods, whereas mean and minimum activities of alanine amino transferase and gamma-glutamyl transferase were higher. The minimum fasting plasma glucose values were more often below the target range in patients with potential interactions. The sulphonylurea dose did not differ significantly between patients who were or were not concomitantly treated with a potentially interacting drug. Concomitant use of a CYP2C9 inhibitor results in exaggerated pharmacodynamic effects of sulphonylureas and increases the risk of hypoglycaemia in T2DM patients receiving glibenclamide, glimepiride or glipizide.

Establishment of a new gastric bypass animal-model with GK rats

To establish a new gastric bypass animal-model with Goto-Kakizaki rats whose different parts of the small intestine were bypassed while stomach was not bypassed. Forty male 3-month-old GK rats were randomly divided into 4 groups: group I (sham operation), group II (duodenum bypassed), group III (jejunum bypassed), group IV (ileum bypassed). Fasting plasma glucose was measured before operation and the 1st, 4th,and 8th week after operation in all the rats, the body weight of all the rats were measured simultaneously. The survival rate of operation for the rats was 95%. Two rats in group IV (died on the first day after operation. The mean fasting plasma glucose concentration of the rats in group II, III, IV (declined obviously 4 weeks after gastric bypass [group II (12.02+/-1.97) vs (6.36+/-0.50) mmol/L, group III (13.42+/-1.66) vs (5.96+/-0.53) mmol/L, group IV (14.32+/-2.82) vs (5.18+/-0.49) mmol/L, all P <0.01], but there were no significant differences among the gastric bypassed groups. The weight of rats in group I, II, III (increased obviously after gastric bypass [group I (253.6+/-9.37) vs (367.0+/-23.70) g, group II (268.2+/-7.95) vs (384.8+/-16.12) g, group III (253.0+/-6.20) vs (323.0+/-16.40) g, all P <0.05] except the rats in group IV ([(262.0+/-13.47) vs(185.8+/-11.56) g]. The mean fasting plasma glucose concentration of the GK rats decreases obviously after gastric bypass through different parts of small intestine. The fasting plasma glucose concentration is not associated with the length of small intestine and body weight.

Physician gender is associated with the quality of type 2 diabetes care

Patient gender influences the quality of medical care whilst the role of physician gender is not well established. To investigate the influence of physician gender on quality of care in patients with type 2 diabetes. Cross-sectional study in 51 053 outpatients (48.6% male), treated by 3096 office-based physicians (66.3% male; 74.0% general practitioners, 21.8% internists and 4.2% diabetologists). Outcome measures included processes of care, intermediate outcomes and medical management. Quality of care measures were based on current ADA guidelines. Hierarchical regression models were used to avoid case-mix bias and to correct for physician-level clustering. Adjusted odds ratios were calculated controlling for age, gender, disease duration and presence of atherosclerotic disease. The patients of female physicians were more often women, more obese, older and had more often atherosclerotic disease (34% in the total cohort). The patients of female physicians more often reached target values in glycaemic control (HbA1c < 6.5%; OR 1.14; 1.05-1.24, P = 0.002), blood lipoproteins (LDL-C < 100 mg dL(-1); OR 1.16; 1.06-1.27, P = 0.002), and blood pressure (systolic values < 130 mmHg; OR 1.11; 1.02-1.22, P = 0.018). They were more likely to receive antihypertensive drug therapy in general (OR 1.35; 1.24-1.46, P < 0.0001) and angiotensin converting enzyme (ACE) inhibitors in particular (OR 1.17; 1.09-1.25, P < 0.0001). The patients of female physicians less often performed glucose self-monitoring (OR 0.83; 0.76-0.91, P < 0.0001) and less often received oral hypoglycaemic agents (OR 0.88; 0.82-0.95, P = 0.001). Physician gender influences quality of care in patients with type 2 diabetes. Female physicians provide an overall better quality of care, especially in prognostically important risk management.

Knowledge, Attitude and Practice of Patients with Diabetes Mellitus before and after Educational Intervention In Jos, Nigeria

Health education is a combination of activities aimed at facilitating changes in behaviour and adoption of practices that should decrease the risk of disease and illness, thereby reducing death and disability. Health education has always been of concern, albeit ignored by many clinicians in the management of people with Diabetes mellitus. In this study we have assessed the short-term effect of health education on knowledge, attitude and practice (KAP) of patients with Diabetes. The study was conducted at the Plateau state chapter of Diabetes Association of Nigeria meetings in the General out-patient department hall of Jos University Teaching Hospital. One hundred regular meeting attendees were randomly selected using the attendance register of the Association and each administered a structured questionnaire consisting of the 3 domains of knowledge, attitude and practice. Responses were documented before and after health education on diabetes over a six month period. Of the 100 patients (42 males and 58 females) administered the questionnaire before the education programme, 86(36males and 50 females) were available for the post-programme test. The mean age (range) of the patients was 52 (16-71) years. The mean (SD) fasting plasma glucose concentration before education was 11.2 (2.1) mmol/l, whereas it fell to a mean (SD) level of 7.2 (1.6) mmol/l after education (p The Journal of Medicine in the Tropics Vol. 9 (1) 2007: pp. 3-10

Relationship between adiponectin and metabolic variables in Caribbean offspring of patients with type 2 diabetes mellitus.

To examine the relationship between adiponectin and metabolic variables in the offspring of patients with type 2 diabetes mellitus. Fasting blood samples and anthropometric indices were taken from 34 subjects, offspring of patients with type 2 diabetes, and 24 healthy control subjects without any immediate family history of diabetes. Plasma glucose and serum adiponectin, insulin, triglycerides, total cholesterol, HDL and LDL cholesterol levels were measured, and insulin resistance (IR) was calculated based on the homeostasis model assessment (HOMA) method. Offspring and control subjects were sex-matched, but the offspring were older and had higher body mass index and waist circumference than the control subjects (p < 0.05). The offspring had significantly higher mean fasting plasma glucose concentrations; however, their mean serum insulin, adiponectin, triglyceride, total cholesterol, HDL and LDL cholesterol and HOMA-derived IR levels did not significantly differ from those of the control subjects (p > 0.05). While the negative correlation between serum adiponectin and HDL cholesterol levels in the offspring remained statistically significant after adjusting for the effect of age, sex and BMI (r = -0.37, p < 0.05), the negative correlation between adiponectin and serum triglyceride, LDL cholesterol or IR levels became non-significant after controlling for the above variables (p > 0.05 in all cases). The correlation between adiponectin and some known biochemical risk factors for developing diabetes and cardiovascular disease in the offspring of patients with diabetes warrants further study to evaluate its potential in assessing the risk of developing these disorders.

Immunologic and non-immunologic association of posttransplant diabetes mellitus (PTDM) a pilot study

Rationale PTDM is associated with morbidity, impairing patient and graft survival. Identifying PTDM risk factors is of interest. Methods Eighty-one kidney transplant recipients during 1995-2002 were evaluated. PTDM was defined as Fasting Plasma Glucose (FPG) >126mg/dl on at least 3 occasions, with the need for anti-hyperglycemic medications. Age, gender, ethnicity, family history of diabetes (FHD), body mass index (BMI), transplant type (living vs. cadaveric donor), mean FPG concentration during first month post-transplant, HLA phenotypes, presence of cytomegalovirus (CMV) and hepatitis-C virus (HCV) antibody were retrospectively examined. Results From 81 patients, 27 had diabetes mellitus prior to transplantation, 9 developed PTDM (17%; Group-I) and 45 did not develop PTDM (Group-II). In Group-I, majority of patients were between ages of 45-59 years (67% vs. 24%; P=0.02) and received cadaveric renal transplant (89% vs. 53%; p=0.0667). Differences in the categories of gender, race, HCV and CMV serology were insignificant between the two groups. A positive recorded FHD was also insignificant between the two groups. BMI was higher in Group-I as compared to Group-II (28.8 ± 0.63 vs. 24.5 ± 0.09; P=0.0075). Mean FPG were significantly elevated during day 0-3, 4-7 and 8-30 in Group-I than Group-II [161.6 ± 3.84 vs. 142.6 ± 0.49 mg/dl (p=0.0376), 138.9 ± 2.70 vs. 114.7 ± 0.40 mg/dl (p=0.0011), 143.4 ± 3.05 vs. 95.7 ± 0.31 mg/dl (p=0.0007), respectively]. Among HLA phenotype, HLA-DR3(18) and B27 were observed more frequently in Group-I (22% vs. 2%; P=NS). Conclusions Elevated FPG within first month, cadaveric renal transplant, older age at transplant, higher BMI, and HLA-DR3(18) and B27 phenotypes may predispose to post-transplant diabetes.

Glycaemic responses after ingestion of 3 local carbohydrate-based foods in West Indian patients with type-2 diabetes mellitus

Background & aim: Previous studies suggest that inadequate glycaemic control in diabetic patients might be related to the type of carbohydrates the patients consume regularly. Thus, we aimed to assess glucose and insulin responses after diabetic and non-diabetic subjects ingested 3 commonly consumed carbohydrate-based foods. Methods: Thirty-eight type-2 diabetic and 27 non-diabetic subjects were studied in 3 different occasions of 7 days apart. On each day of the study, anthropometric indices were measured and after collecting fasting blood samples, subjects randomly consumed bread, roti or rice within 10 min. Subsequently 7 ml of venous blood samples were collected at 60, 90, 120 and 150 min for determination of glucose and insulin responses. Results: Although the diabetic patients were older than the healthy subjects ( P<0.05), both subjects had similar weight, body mass index and waist and hip circumferences ( P>0.05). The mean fasting and post meal plasma glucose concentrations for the 3 test foods were higher in diabetic patients than the corresponding values for the healthy subjects (all; P<0.001). Generally, roti elicited the highest total incremental glucose responses in the diabetic patients irrespective of ethnic group ( P<0.05). Conclusion: There were variations in glucose and insulin responses to the 3 test foods. However, roti elicited the highest postprandial hyperglycaemia and should therefore be discouraged in regular dietary plan of diabetic patients.