Significant Decrease In HOMA-IR Research Articles

Effects of continuous positive airway pressure upon the un-treatment hour changes of blood glucose level in patients with obstructive sleep apnea hypopnea syndrome and type 2 diabetes

To assess the effects of short-term continuous positive airway pressure (CPAP) upon un-treatment hour glucose control via a continuous glucose monitoring system (CGMS) in patients with obstructive sleep apnea hypopnea syndrome and type 2 diabetes (OWD). A total of 23 case of hospitalized OWD were recruited. CGMS was applied for 2 days before and 4 days during CPAP treatment. The treatment hour (6 h, 0:00 - 6:00) and un-treatment hour (14 h, 6:00 - 22:00) glucose level and glucose variability were analyzed. Insulin resistance was assessed with fasting plasma blood glucose (FPG), plasma insulin (FINS) and homeostatic model assessment of insulin resistance index (HOMA-IR). The short-term CPAP treatment corrected sleep-disordered breathing and induced significant decreases of treatment and un-treatment hour glucose level ((7.07 ± 2.02) mmol/L vs (6.34 ± 1.57) mmol/L, (8.04 ± 1.99) mmol/L vs (7.64 ± 1.81) mmol/L, both P < 0.05). Glucose variability of treatment and un-treatment hours significantly decreased after CPAP treatment (0.41 ± 0.24 vs 0.29 ± 0.18, 1.02 ± 0.50 vs 0.78 ± 0.45, all P < 0.05). Short-term treatment also induced an increase of insulin sensitivity, as indicated by a significant decrease of HOMA-IR (4.02 ± 2.07 vs 3.08 ± 1.58, P < 0.05). Short-term CPAP treatment in OWD may improve not only insulin resistance but also blood glucose and glucose variability during treatment and un-treatment hours.

Pro-Inflammatory wnt5a and Anti-Inflammatory sFRP5 Are Differentially Regulated by Nutritional Factors in Obese Human Subjects

BackgroundObesity is associated with macrophage infiltration of adipose tissue. These inflammatory cells affect adipocytes not only by classical cytokines but also by the secreted glycopeptide wnt5a. Healthy adipocytes are able to release the wnt5a inhibitor sFRP5. This protective effect, however, was found to be diminished in obesity. The aim of the present study was to examine (1) whether obese human subjects exhibit increased serum concentrations of wnt5a and (2) whether wnt5a and/or sFRP5 serum concentrations in obese subjects can be influenced by caloric restriction.Methodology23 obese human subjects (BMI 44.1±1.1 kg/m2) and 12 age- and sex-matched lean controls (BMI 22.3±0.4 kg/m2) were included in the study. Obese subjects were treated with a very low-calorie diet (approximately 800 kcal/d) for 12 weeks. Body composition was assessed by impedance analysis, insulin sensitivity was estimated by HOMA-IR and the leptin-to-adiponectin ratio and wnt5a and sFRP5 serum concentrations were measured by ELISA. sFRP5 expression in human adipose tissue biopsies was further determined on protein level by immunohistology.Principal FindingsPro-inflammatory wnt5a was not measurable in any serum sample of lean control subjects. In patients with obesity, however, wnt5a became significantly detectable consistent with low grade inflammation in such subjects. Caloric restriction resulted in a weight loss from 131.9±4.0 to 112.3±3.2 kg in the obese patients group. This was accompanied by a significant decrease of HOMA-IR and leptin-to-adiponectin ratio, indicating improved insulin sensitivity. Interestingly, these metabolic improvements were associated with a significant increase in serum concentrations of the anti-inflammatory factor and wnt5a-inhibitor sFRP5.Conclusions/SignificanceObesity is associated with elevated serum levels of pro-inflammatory wnt5a in humans. Furthermore, caloric restriction beneficially affects serum concentrations of anti-inflammatory sFRP5 in such subjects. These findings suggest a novel regulatory system in low grade inflammation in obesity, which can be influenced by nutritional therapy.

In Patients with HIV-Infection, Chromium Supplementation Improves Insulin Resistance and Other Metabolic Abnormalities: A Randomized, Double-Blind, Placebo Controlled Trial

Chromium is an essential micronutrient; chromium deficiency has been reported to cause insulin resistance, hyperglycemia and hyperlipidemia. The aim was to investigate the effect of chromium supplementation on insulin-resistance, other metabolic abnormalities, and body composition in people living with HIV. This was a randomized, double-blind, placebo-controlled trial. Fifty-two HIV-positive subjects with elevated glucose, lipids, or evidence of body fat redistribution, and who had insulin-resistance based on the calculation of homeostasis model of assessment (HOMA-IR > or = 2.5) were assessed. Subjects who were on insulin or hypoglycemic medications were excluded. Subjects were randomized to receive either 400 microg/day chromium-nicotinate or placebo for 16 weeks. Forty-six subjects, 23 in each group, completed the study. Fasting blood insulin, glucose, lipid profile and body composition were measured before and after intervention. Chromium was tolerated without side effects and resulted in a significant decrease in HOMA-IR (median (IQR) (pre:4.09 (3.02-8.79); post: 3.66 (2.40-5.46), p=0.004), insulin (pre: 102 (85-226); post: 99 (59-131) pmol/L, p=0.003), triglycerides, total body fat mass (mean+/-SEM) (pre: 17.3+/-1.7; post: 16.3+/-1.7 kg; p=0.002) and trunk fat mass (pre: 23.8+/-1.9; post: 22.7+/-2.0 %; p=0.008). Blood glucose, C-peptide, total, HDL and LDL cholesterol, and hemoglobin A1c remained unchanged. Biochemical parameters did not change in the placebo group except for LDL cholesterol which increased significantly. Body weight and medication profile remained stable throughout the study for both groups. In summary, chromium improved insulin resistance, metabolic abnormalities, and body composition in HIV+ patients. This suggests that chromium supplements alleviate some of the antiretroviral-associated metabolic abnormalities.

복합운동 강도가 기숙형학교 여고생의 신체조성, HOMA-IR 및 HbA1c에 미치는 영향

Among students of 'K' boarding high school, located in ‘B’ city, 32 students whose % body fat was 30% or above were divided into three groups - two exercise groups and one control group. They performed Combined Training - a mix of weight training (WT) and step box training (SBT) - for 65 min a day, 3 days a week, for 8 weeks in total. Group A performed WT 70-80%RM×3 sets+SBT (RPE 11-13)×1 set, and group B performed WT 70-80%RM×1 set+SBT (RPE 11-13)×3 sets to yield data on changes of body composition (Soft Lean Mass, SLM), %fat, WHR), HbA1c, and HOMA-IR. Paired t-test was used to process data within each group. Pre- and post experiment differences rates (%diff) were used to perform one-way ANOVA (Duncan test) for group comparisons. The conclusions derived are as follows. Regarding body composition, exercise groups showed an increase in SLM, but there was no such change in the control group. WHR decreased in group A, but increased in the control group. The % body fat decreased in both exercise groups, but increased in the control group. As for the group comparisons, SLM in group A showed a greater increase than in group B and the control group. WHR in groups A and B showed a greater decrease than the control group. The % body fat in groups A and B showed a greater decrease than the control group. The exercise groups showed a significant decrease in HOMA-IR, but the control group showed a significant increase in HOMA-IR. As for the group comparisons, groups A and B showed a greater decrease in HOMA-IR than the control group. The exercise groups showed a significant decrease in HbA1c, however, the control group showed no change in HbA1c. As for the group comparisons, group A showed a greater decrease in HbA1c than the control group. These results confirm that combined training is more effective in improving body composition and metabolic factors when it includes a high proportion of resistance training, rather than aerobic exercise. The results of the study suggest that it is advisable to set a high proportion of WT when deciding the intensity of combined training.

Response of oxidative stress markers and antioxidant parameters to an 8-week aerobic physical activity program in healthy, postmenopausal women

The aim of the study was to assess the influence of an 8-week aerobic physical activity program on oxidative stress markers, antioxidant parameters, and selected metabolic parameters in healthy, postmenopausal women. The study was carried out in a group of 41 healthy women (mean age 65 years) participating in an 8-week cycle ergometer physical workout of moderate intensity. Before and after completing the training program, the following parameters were assessed: total antioxidant status (TAS) and concentrations of thiobarbituric acid reactive substances (TBARS) in plasma, serum levels of antibodies against oxidatively modified low-density lipoproteins (LDL) (oLAB), serum concentrations of glucose, high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), insulin, and reduced glutathione (GSH) concentrations in red blood cells (RBC). Atherogenic index of plasma (AIP) and insulin resistance index (HOMA IR) were calculated. The 8-week aerobic physical activity program resulted in significant decrease ( p < 0.01) in serum glucose and LDL-cholesterol (LDL-C) levels, plasma TBARS concentrations ( p < 0.05), and in significant decrease of HOMA IR ( p < 0.01). TAS of plasma and GSH concentrations in RBC increased significantly ( p < 0.01) over the study period. The results show that an 8-week aerobic training enhanced insulin sensitivity, and improved the balance between oxidants and antioxidants in healthy, postmenopausal women.

Improvement of endothelial function with metformin and rosiglitazone treatment in women with polycystic ovary syndrome

There is evidence of preclinical cardiovascular disease even in young women with polycystic ovary syndrome (PCOS). The aim of our study was to assess and compare the effects of metformin (MET) and rosiglitazone (ROSI) on endothelial function in PCOS patients. For 6 months, 26 women with PCOS received either MET or ROSI. Blood samples for assessment of androgens, lipids, and high-sensitive C-reactive protein were taken at baseline and at endpoint. Endothelium-dependent flow-mediated dilation (FMD) and glyceryl trinitrate-induced endothelium-independent dilation of brachial artery were studied before and after treatment. Homeostasis model assessment (HOMA(IR)) calculation was applied as a measure of insulin resistance (IR). With treatment, FMD of brachial artery improved significantly from 4.2+/-6.6 to 10.2+/-5.9% in MET group (P=0.036) and from 2.9+/-3.2 to 7.6+/-4.9% in ROSI group (P=0.026), MET being as effective as ROSI (P=0.70). The endothelium-independent dilation did not change. Additionally, administration of MET was associated with a significant decrease in HOMA(IR) (P=0.003), serum total and serum-free testosterone (P=0.045 and P=0.008 respectively) and significantly higher frequencies of menstrual bleeding (P=0.006). A 6-month therapy with insulin sensitizers, MET and ROSI, resulted in marked improvement of endothelial function in young PCOS patients without clinically evident atherosclerosis who were not severely insulin resistant. Neither drug was superior to the other. We conclude that therapeutic intervention with either insulin sensitizer may reverse the atherosclerotic process in PCOS patients at its early stage.

P368 IS HBA1C CORRELATED TO RESTING ENERGY EXPENDITURE IN TYPE 2 DIABETIC PATIENTS? A PILOT STUDY

leptin, ultrasensitive CRP (usCRP), IL1-beta, IL6, TNFalpha and homocystein prior and after treatment. Results: In the whole group we founded a decrease in ALT levels in 43 patients (58.10%) reaching normal levels only in 22 (29.72%). There was a decrease in HOMA-IR, PCRus, IL-6, homocystein and ferritin, reaching statistical significance only in leptin levels (1.99±2.21 vs 1.05±1.12; p = 0.023) observed in 53 patients (71.62%). Analyzing pre-treatment ALT elevated levels patients subgroup we founded a significant decrease in HOMA-IR in those that reach normal levels in contrast with those with persistent elevated ALT levels (4.23±2.83, 2.36±1.19, 4.07±3.72; p = 0.02), accompanied of a significant decrease TNFalpha (6.80±1.61, 4.67±1.28, 6.82±2.66; p = 0.007). We had similar results regarding to TNF-alpha in patients with elevated pre-treatment HOMA-IR that reach normality (6.80±1.61, 4.06±1.5, 7.56±0.80; p = 0.04). In spite of a decrease in other proinflammatory factors level after 6mo of treatment in this subgroup, they not reach statistical significance. We not observed significant decrease in patients with normal pre-treatment ALT or HOMA-IR <3.9. Conclusion: After 6 mo of integral treatment of patients with NAFLD, persisted a proinflammatory state in spite of a decrease in insulin-resistance (HOMA-IR) and factors related. This decrease reached statistical significance in patients with pre-treatment elevated ALT levels that normalised them, reinforcing a role HOMA-IR and TNFalfa in such elevated levels.

Insulin Sensitivity in Women with Coronary Heart Disease during Hormone Replacement Therapy

The aim of the present study was to evaluate the effect on insulin secretion and insulin sensitivity of hormone replacement therapy (HRT) with short-term unopposed transdermal 17beta-estradiol and, after 1 year, when combined with intermittent medroxyprogesterone acetate (MPA). Ninety-nine postmenopausal women with coronary artery disease (CAD), but without diabetes mellitus, consecutively recruited from patients referred for invasive coronary investigations at a tertiary university clinic, were randomized to either HRT or a control group. Unopposed estradiol was given for 3 months, and MPA was added in cycles of 14 days every 3 months. Clinical investigations were undertaken at baseline and after 3 months and 12 months. Insulin sensitivity index (HOMA-IR) and insulin secretion (HOMA-BCF) were calculated using the homeostasis model assessment. Compared with the control group, treatment with unopposed transdermal 17beta-estradiol caused a significant decrease in HOMA-IR, that is, improved insulin sensitivity, but after combination with MPA and 12 months of HRT, no change was observed in HOMA-IR. Similarly, a transient decrease was observed for plasma levels of C peptide after unopposed 17beta-estradiol. HOMA-BCF remained unchanged throughout the study period. Sex hormone-binding globulin (SHBG) was related to HOMA-IR but not to HOMA-BCF at baseline. The association with HOMA-IR grew stronger after unopposed transdermal estradiol. No deleterious effect of HRT on glucose metabolism was found in postmenopausal women with CAD. Short-term treatment with unopposed transdermal estradiol caused a decrease in insulin resistance, but long-term treatment after intermittent MPA was introduced had no effect on either insulin secretion or insulin resistance.

Rosiglitazone improves glucose metabolism in nondiabetic uremic patients on CAPD

Background:Insulin resistance, a strong risk factor for atherosclerotic vascular disease, is present in uremic patients without diabetes on continuous ambulatory peritoneal dialysis (CAPD) therapy. Amelioration of insulin resistance may reduce associated long-term cardiovascular complications. The aim of the study is to investigate the effects of rosiglitazone (ROS), an insulin sensitizer, on glucose metabolism in CAPD patients without diabetes. Methods:Fifteen uremic patients without diabetes on CAPD therapy were enrolled. All were administered ROS, 4 mg/d, for 12 weeks. A control group consisted of 15 age- and sex-matched healthy subjects. Oral glucose tolerance test (OGTT) results, fasting glucose and insulin levels, related blood biochemistry results, and C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels were determined before initiation and at 4 and 12 weeks of therapy. Insulin resistance was evaluated using the homeostasis model assessment method (HOMA-IR). A whole-body insulin sensitivity index (ISI) and insulinogenic index for insulin production were calculated from OGTT results. Results:CAPD patients showed significantly greater HOMA-IR and glucose intolerance compared with healthy controls. After 4 and 12 weeks of ROS therapy, there were no significant changes in body weight, blood pressure, dialysis adequacy, hemoglobin level, hemoglobin A1c level, liver function, lipid profile, or intact parathyroid hormone, CRP, IL-6, or TNF-α levels. There was a significant decrease in HOMA-IR (3.2 ± 0.6, 2.2 ± 0.4, and 2.1 ± 0.4; P < 0.05). During the OGTT, there was a significant decrease in the area under the glucose curve and a significant increase in ISI (3.5 ± 0.4, 5.0 ± 0.7, and 5.3 ± 0.7; P < 0.05), but no significant change in insulinogenic index. Conclusion:ROS improved insulin resistance in CAPD patients without diabetes. Whether long-term use of ROS reduces cardiovascular risk needs further study.