RESUMO
AIMS: We evaluated the relations between surrogate indices of insulin resistance and waist circumference, metabolic syndrome and coronary heart disease risk across Hispanic and non-Hispanic white populations. METHODS: The study was a cross-sectional analysis of participants without diabetes in the San Antonio Heart Study, Mexico City Diabetes Study and Spanish Insulin Resistance Study. We evaluated commonly used indices of insulin resistance, including homeostasis model assessment, McAuley's index, Gutt's insulin sensitivity index, Avignon's insulin sensitivity index and the Stumvoll index with and without demographics, the modified Matsuda index and the product of the triglycerides and glucose index. The metabolic syndrome was defined by American Heart Association/National Heart, Lung, and Blood Institute criteria and coronary heart disease risk by Framingham risk scores. RESULTS: The Stumvoll index with demographics and the Avignon's insulin sensitivity index had the strongest correlations with waist circumference across populations. The triglycerides and glucose and McAuley's indices had the most robust correlations with Framingham risk score. The triglycerides and glucose index had the greatest ability to detect individuals with the metabolic syndrome and ≥ 10% coronary heart disease risk. Some indices display significant variability in the strength of the relationship with adiposity and coronary heart disease risk across populations. CONCLUSIONS: There are significant differences between insulin resistance indices regarding the ability to detect the metabolic syndrome and coronary heart disease risk across populations. Studies may need to consider the index of insulin resistance that best suits the objectives.
Assuntos
Glicemia/metabolismo , Doenças Cardiovasculares/sangue , Hispânico ou Latino/estatística & dados numéricos , Resistência à Insulina , Síndrome Metabólica/sangue , Triglicerídeos/sangue , Circunferência da Cintura , População Branca/estatística & dados numéricos , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Jejum/sangue , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: Mexican-American populations in San Antonio, Texas (SA-MA) and Mexico have a higher prevalence of type 2 diabetes than non-Hispanic whites in San Antonio (SA-NHW). However, the higher prevalence of type 2 diabetes in Mexican-origin populations might be related, in part, not to Native American genetic admixture but to Spanish genetic admixture. RESEARCH DESIGN AND METHODS: Four population-based epidemiological surveys conducted with Mexican-origin and European-origin samples provided data relevant to this question. In all four surveys, type 2 diabetes was defined as fasting plasma glucose > or =7.0 mmol/l or 2-h glucose > or =11.1 mmol/l or use of antidiabetic agents. RESULTS: A comparison of the two Mexican-origin populations showed that the age- and sex-adjusted prevalence of type 2 diabetes was lower in Mexico than in SA-MA (15.1 vs. 17.9%, P = 0.032). Between the two European-origin populations, the prevalence of type 2 diabetes was lower in SA-NHW than in Spain (6.2 vs. 9.1%, P < 0.0001), but differences were attenuated by adjustment for BMI or after stratification by education. In logistic regression analyses, type 2 diabetes was associated with Mexican ethnic origin after adjusting for age, education, BMI, and waist-to-hip ratio. CONCLUSIONS: The prevalence of type 2 diabetes in Spain was intermediate between that in Mexican-origin populations and SA-NHW. Although the higher degree of Native American admixture is a major contributor to the higher rates of type 2 diabetes, we cannot completely rule out a partial contribution of Spanish admixture to diabetes susceptibility among Mexican- origin populations.
Assuntos
Diabetes Mellitus Tipo 2/genética , Hispânico ou Latino , Fatores Etários , Constituição Corporal , Índice de Massa Corporal , Escolaridade , Resistência à Insulina , Modelos Logísticos , México/epidemiologia , México/etnologia , Razão de Chances , Espanha/epidemiologia , Texas/epidemiologiaAssuntos
Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/imunologia , Antígenos HLA-DQ/genética , Antígenos HLA-DR/genética , Alelos , Criança , Chile , Diabetes Mellitus Tipo 1/epidemiologia , Frequência do Gene , Predisposição Genética para Doença , Cadeias alfa de HLA-DQ , Cadeias beta de HLA-DQ , Cadeias HLA-DRB1 , Homozigoto , Humanos , Valores de Referência , Fatores de RiscoRESUMO
The propensity of an individual to develop type I (insulin dependent) diabetes mellitus is directly related to specific HLA class II proteins, specially those from DR and DQ regions. Genetic susceptibility to insulin dependent diabetes arises from a preestablished conformation of alpha and beta chains of DQ and beta chain of DR. Since the classic demonstration by McDevitt and colleagues that DQ beta chain aspartate at position 57 was protective against the development of the disease, many populations have been surveyed to study the association between the incidence Type I diabetes and determined frequencies of DR and DQ haplotypes. The association between these markers and susceptibility to Type I diabetes is well established in caucasians at the present time. However, little information is available for Latin American populations, that share a mixture of european, african and native genes. Our group is studying genetic markers of three Latin American populations (Argentina, Perú and Chile) and their possible association to the different incidence of Type I diabetes mellitus in each country.
Assuntos
Diabetes Mellitus Tipo 1/genética , Genes MHC da Classe II/genética , Antígenos HLA/genética , Diabetes Mellitus Tipo 1/etnologia , Suscetibilidade a Doenças , Marcadores Genéticos , Haplótipos/genética , Humanos , Fatores de RiscoRESUMO
AIMS: To study serum Lp(a) levels and other metabolic cardiovascular risk factors in children with type I diabetes mellitus (DM) in comparison with sex and age matched nondiabetic children. To determine the influence of diabetes control on serum lipoprotein (a) concentrations. DESIGN: Transversal observational study. TARGET POPULATION: diabetic group: 70 type I DM children without microalbuminuria and no macro-microvascular nor neurological complications, aged from 8 to 15 years; 30 boys, 40 girls. Mean duration of type I DM was 8 +/- 4 years. Non diabetic group: composed by 123 healthy children with no family history of DM, aged from 8 to 15 years, 53 boys, 70 girls. METHODS: The lipids profile include: total cholesterol (TC) and triglyceride (TG), cholesterol high-density lipoproteins (C-HDL) cholesterol very-low-density lipoproteins (C-LDL) and cholesterol low-density lipoproteins (C-LDL). ApoAI, APOAII and ApoB, Lp(a) and fructosamine. RESULTS: Fructosamine concentration in diabetic children was 340 +/- 108 uM/1 in 240 +/- 25 uM/l nondiabetic children. Lp(a) serum levels did not significantly differ among both groups 17 +/- 16 mg/dl in diabetics 19 +/- 18 mg/dl in controls. Multivariate analysis showed that in the diabetic children the worsening of metabolic control as reflected by fructosamine, was positively correlated with the increase in total Lp(a) serum concentration. CONCLUSIONS: In children aged 8-15 years with uncomplicated IDDM lasting less than 15 years duration, Lp(a) serum levels are positively correlated with the poorest metabolic control.
Assuntos
Diabetes Mellitus Tipo 1/sangue , Lipoproteína(a)/sangue , Adolescente , Criança , Chile , Doença das Coronárias/etiologia , Feminino , Humanos , Masculino , Fatores de RiscoRESUMO
Diabetes mellitus is associated with a three to fourfold increased risk for coronary artery disease and diabetic patients frequently have an abnormal plasma lipid profile. Lately, lipoprotein (a) has received attention as an important independent risk factor for cardiovascular disease. This lipoprotein is elevated in patients with type II diabetes mellitus and there may be an association between the metabolic control of these subjects and its levels. In this review the main features of lipoprotein (a) and its relationship to the fibrinolytic system and atherosclerosis are reviewed.
Assuntos
Arteriosclerose/etiologia , Diabetes Mellitus/sangue , Lipoproteína(a)/sangue , Feminino , Humanos , Lipoproteína(a)/química , MasculinoRESUMO
Se describe el fenómeno del alba o doron phenomenon (hiperglicemica em ayuenas sin hipoglicemia previa y sin hipoensulinemia en las hosas del alba, es decir entre 5-8 horas de la mañana) , su método de valoración, frecuencia, patogenica y fisiopatología,m así como el papel patogénico de la hormona de crescimento y su hiperproducción en diabetes mellitus insulinodependiente
Assuntos
Humanos , Glicemia , Diabetes Mellitus Tipo 1/fisiopatologia , Hormônio do Crescimento/fisiologia , Homeostase , Sono/fisiologia , Hiperglicemia , Resistência à Insulina , Insulina/sangueRESUMO
Se describe el fenómeno del alba o doron phenomenon (hiperglicemica em ayuenas sin hipoglicemia previa y sin hipoensulinemia en las hosas del alba, es decir entre 5-8 horas de la mañana) , su método de valoración, frecuencia, patogenica y fisiopatología,m así como el papel patogénico de la hormona de crescimento y su hiperproducción en diabetes mellitus insulinodependiente (AU)
Assuntos
Humanos , Homeostase , Glicemia , Diabetes Mellitus Tipo 1/fisiopatologia , Sono/fisiologia , Hormônio do Crescimento/fisiologia , Hiperglicemia , Insulina/sangue , Resistência à InsulinaRESUMO
Las sulfonilureas, en particular las de segunda generación, son objeto de un creciente interés debido principalmente a que hoy en día se está comenzando a comprender la fisiopatología de la Diabetes Mellitus no Insulinodependiente (DMNID). La acción hipoglucemiante producida por estos fármacos a corto plazo es conocida desde hace tiempoñ sin embargo su acción a largo plazo no está totalmente clara. Varios son los mecanismos invocados, pero probablemente sólo dos de ellos están involucrados: la potenciación de la acción de la insulina a nivel periférico y la disminución de la producción hepática de glucosa. La potenciación de la acción de la insulina se realiza a nivel posreceptor, teniendo como principal consecuencia una disminución de la insulinorresistencia presente en los pacientes con DMNID. El mecanismo por el cual se produce la disminución de la producción hepatica de glucosa no está tan bien clarificado como el anterior. Sin embargo se ha observado una variación en unn metabolito intracelular, la fructosa 2,6-difosfato, que podría ser uno de los mecanismos subyacentes en los efectos posreceptor de aquellas sulfonilureas
Assuntos
Humanos , Diabetes Mellitus Tipo 2 , Compostos de Sulfonilureia/farmacologia , Glicemia/análise , Fígado , Insulina/metabolismoRESUMO
Las sulfonilureas, en particular las de segunda generación, son objeto de un creciente interés debido principalmente a que hoy en día se está comenzando a comprender la fisiopatología de la Diabetes Mellitus no Insulinodependiente (DMNID). La acción hipoglucemiante producida por estos fármacos a corto plazo es conocida desde hace tiempoñ sin embargo su acción a largo plazo no está totalmente clara. Varios son los mecanismos invocados, pero probablemente sólo dos de ellos están involucrados: la potenciación de la acción de la insulina a nivel periférico y la disminución de la producción hepática de glucosa. La potenciación de la acción de la insulina se realiza a nivel posreceptor, teniendo como principal consecuencia una disminución de la insulinorresistencia presente en los pacientes con DMNID. El mecanismo por el cual se produce la disminución de la producción hepatica de glucosa no está tan bien clarificado como el anterior. Sin embargo se ha observado una variación en unn metabolito intracelular, la fructosa 2,6-difosfato, que podría ser uno de los mecanismos subyacentes en los efectos posreceptor de aquellas sulfonilureas (AU)