RESUMO
With the purpose of determining how certain risk factors for type 2 diabetes such as family history of diabetes, obesity and dyslipidemia, affect the glucose-insulin response to a glucose challenge, 135 individuals (77 women and 58) men were studied. Their ages ranged from 20-68 years, their basal glycemic values were less than 110 mg/dL but they were considered at risk for diabetes due to the presence of one or more of those factors. We found that the presence of those risk factors did not affect the glycemic response in any case. However, the basal insulin levels as well as the post-challenge values were increased significantly (p < 0.0001) by the presence of obesity in men as well as in women. Dyslipidemia increased the basal and post challenge glucose insulin values only in men (p < 0.002). The coexistence of obesity and family history of diabetes provoked a decrease in the basal insulin levels as well as in the insulin response to glucose. We conclude that, without alteration of the glycemic response, the presence of risk factors as obesity, dyslipidemia or family history of diabetes leads to basal hyperinsulinemia, as well as glucose stimulated hyperinsulinemia, however the coexistence of obesity and family history of diabetes, is responsible for a deficit in the insulin secretion by the pancreas.
Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/epidemiologia , Teste de Tolerância a Glucose , Hiperinsulinismo/epidemiologia , Insulina/análise , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Índice de Massa Corporal , Comorbidade , Diabetes Mellitus Tipo 2/genética , Suscetibilidade a Doenças , Jejum/sangue , Feminino , Predisposição Genética para Doença , Glucose , Humanos , Hiperinsulinismo/diagnóstico , Hiperinsulinismo/genética , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/epidemiologia , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/genética , Fatores de RiscoRESUMO
Hyperinsulinemia and impaired insulin action are familial and predictive of Type 2 diabetes onset. Since high levels of insulin are characteristic of our general (venezuelan)hispanic population, the purpose of this investigation was to identify early metabolic defects in a group of healthy first degree relatives of Type 2 diabetic patients. We studied 46 (29 women and 17 men; ages ranging 18-66 y) first degree relatives of Type 2 diabetic patients comparing them with 22 (12 women and 10 men; ages ranging 22-60 y) subjects who had no family history of diabetes. All subjects underwent resting blood pressure and anthropometric measurements; a 75 g oral glucose tolerance test with determination of glucose and insulin and a fasting lipid profile. The relatives of Type 2 diabetic patients had higher tricipital (TC) and subscapular (SC) skinfolds, and elevated DBP in relation to the control group. The skinfolds elevation was more evident in women, while in men the elevation in DBP predominates. None of the relatives had glucose intolerance, however, the glucose-stimulated insulin response was elevated at all points in men as well as in women. No difference was observed in the HOMA values for IR and beta cell function, or in the delta I30/delta G30 ratio. The lipid profile showed a marked elevation in TG levels in men as well as in women, with low HDL-C values in men. No other lipid abnormalities were observed. Correlation analysis revealed strong association between BMI and WHR with skinfolds and several parameters of the carbohydrate metabolism in women, but not in men. IR in women was possitively associated with skinfolds, SBP and lipid parameters and beta cell function with VLDL-C. Adult relatives of Type 2 diabetic venezuelan patients from hispanic origin had, early in their lives, several parameters of the metabolic syndrome as hyperinsulinemia, obesity, dyslipidemia and high blood pressure. These alterations were more prominent in women, group in which the association among BMI, WHR and IR were statistically significant respect to SBP, DBP, basal insulin, insulin/glucose ratio, TG and HDL-C.
Assuntos
Diabetes Mellitus Tipo 2/genética , Saúde da Família , Hiperinsulinismo/genética , Resistência à Insulina/genética , Estado Pré-Diabético/genética , Adulto , Idade de Início , Antropometria , Glicemia/análise , Metabolismo dos Carboidratos , HDL-Colesterol/sangue , Comorbidade , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Predisposição Genética para Doença , Teste de Tolerância a Glucose , Humanos , Hiperinsulinismo/epidemiologia , Hiperinsulinismo/etnologia , Hipertensão/epidemiologia , Hipertensão/etnologia , Hipertensão/genética , Hipertrigliceridemia/epidemiologia , Hipertrigliceridemia/etnologia , Hipertrigliceridemia/genética , Incidência , Insulina/sangue , Insulina/metabolismo , Secreção de Insulina , Ilhotas Pancreáticas/metabolismo , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/etnologia , Obesidade/genética , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/etnologia , Fatores de Risco , Fatores Sexuais , Espanha/etnologia , Venezuela/epidemiologiaRESUMO
El objetivo del trabajo fue evaluar la eficacia y tolerancia de glimepirida en pacientes con diagnóstico de Diábetes Mellitus tipo 2 en Venezuela. Mediante un estudio multicéntrico abierto, no randomizado, prospectivo, de Glimepirida en pacientes diabéticos tipo 2. Dosis de inicio: 1 mg de glimepirida, de acuerdo a las respuesta se aumenta la dosis en 1 mg cada 2 semanas hasta alcanzar una glicemia en ayunas menor o igual a 140 mg/dl. El período total de observación fue de 12 semanas. Se realizó un control cada dos semanas. Se estudió una muestra de 258 pacientes diabéticos tipo 2 que no estaban controlados adecuadamente con dieta, ejercicios y/o tratamiento hipoglicemiante, quienes recibieron glimepirida por primera vez o cambiaron su tratamiento a glimepirida. Todos los datos se analizaron mediante la prueba T de Student con dos colas. Se consideró resultado estadísticamente significativo a los valores de p<0.05 en lo que se refiere a disminución de glicemia por cada consulta. Al inicio del estudio la glicemia en ayunas se encontraba en valores de 225,55 ñ 67 mg/dl. Al término del estudio la glicemia obtenida fue 127,80 ñ 42 mg/dl. La glicemia disminuyo en promedio un 44 por ciento luego de 12 semanas de tratamiento. 93 por ciento de casos lograron control adecuado de la glicemia. No se presentaron efectos secundarios en 91 por ciento de los casos. Ocurrieron reacciones adversas en 21 pacientes (9 por ciento de los casos), de los cuales 11 casos corresponden a episodios de hipoglicemia. La hipoglicemia fue leve o moderada en todos los casos no ameritando hospitalización. Glimepirida demostró eficacia terapéutica al disminuir los niveles de glicemia en ayunas a valores menores o iguales a 140 mg/dl en el 79,53 por ciento de los pacientes, significativo estadísticamente, con un excelente perfíl de seguridad (91 por ciento de los casos no reportaron efectos secundarios
Assuntos
Humanos , Masculino , Feminino , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/terapia , Hipoglicemia/terapia , Hipoglicemiantes/uso terapêutico , VenezuelaRESUMO
This study reports a 7-y-old boy with severe hypertriglyceridaemia who was successfully treated for 6 y with a low glycaemic index-high carbohydrate modified-lipid diet that produced beneficial changes in triglyceride and total cholesterol levels. It is suggested that a selection of a complex digestible carbohydrate and an adequate ratio between polyunsaturated and monounsaturated fat may, in the long term, favourably improve the lipid profile.
Assuntos
Carboidratos da Dieta/uso terapêutico , Hipertrigliceridemia/dietoterapia , Criança , Dieta Aterogênica , Dieta com Restrição de Gorduras , Humanos , Hipertrigliceridemia/diagnóstico , Hipertrigliceridemia/fisiopatologia , Masculino , Triglicerídeos/sangueRESUMO
The aim of this study was to evaluate the alterations of the lipoprotein composition and their relation with the insulin-resistance and/or hyperinsulinemia in non diabetic obese patients. Twenty-two no obese(13 women and 9 men) and 30 obese patients (BMI > 30) were studied, who were divided into two groups according to the total lipid levels. The first group was formed by 18 obese patients (10 women and 8 men) with normal serum cholesterol (Chol) concentration < 200 mg/dL and triglycerides (TG) < 150mg/dL (NO), while the second group were formed by 12 obese patients (3 women and 9 men) with elevated Chol level > 200mg/dL and/or TG > 150 mg/dL (HO). A clinical and anthropometric examination was performed to each patient, as well as a glucose tolerance test, including serum glucose and insulin determinations. Likewise, the plasma lipoproteins (VLDL, LDL, HDL2 and HDL3) were isolated by ultracentrifugation and their cholesterol and triglycerides content were determined by enzymatic methods. In this report, we demonstrate the existence of compensatory basal hyperinsulinemia in men and women on both obese patients populations as well as alterations in the lipoprotein composition, mostly a TG overload even on NO. On the other hand, the presence of lipids and lipoproteins modification were obvious in those patients with abdominal obesity, on whom the hyperinsulinemia was more evident, which could be related with the high risk of cardiovascular disease in this kind of patients.
Assuntos
Hiperlipidemias/sangue , Lipoproteínas/sangue , Obesidade/sangue , Adulto , Antropometria , Glicemia/análise , Doenças Cardiovasculares/epidemiologia , Colesterol/sangue , Feminino , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Triglicerídeos/sangueRESUMO
To determine the most frequent dyslipidemias among first-degree relatives of NIDDM patients, and its association with their glucose-tolerance status and hyperinsulinemia, we have started to examine members of NIDDM pedigrees, according to American Diabetes Association guidelines for nuclear family studies. In a large family with 2 NIDDM siblings in the 2nd generation, and 4 siblings with NIDDM in the 3rd generation, we have evaluated 14 first degree relatives and also 15 sex and aged matched healthy control subjects without family history of diabetes. The NIDDM relative group presented BMI = 31.8 +/- 3.9 kg/m2, SBP = 128 +/- 18.2 mmHg, DBP = 84 +/- 12.7 mmHg. Both relatives and controls were subjected to a 2h 75g OGTT for glucose and insulin determinations. Although none of NIDDM relatives has IGT, both Glycemic Area (GA) and Insulin Area (IA) were greater (p < 0.01) in the NIDDM relative group. The Insulin/Glucose ratio was also higher (p < 0.01) at 0 and 120 min of OGTT, this might be indirect evidence of Insulin- Resistance. Fasting serum lipids in the NIDDM relatives were TG = 148 +/- 24mg/dl, T-Chol = 244 +/- 10.7mg/dl, HDL-C = 34.2 +/- 2.5mg/dl; lipids in the control group were TG = 84.8 +/- 10.1mg/dl, T-Chol = 167 +/- 10.2mg/dl, HDL-C = 44.4 +/- 2.6mg/dl. Electrophoretic pattern showed type IIa (30.7%) and IIb (61.5%) hyperlipidemias in the NIDDM relatives. In this group, there was a positive and significant association between basal insulin and DBP (r = 0.67; p < 0.01), and between DBP and both TG (r = 0.74; p < 0.01)) and VLDL-C (r = 0.58; p < 0.05). It was also obtained a negative association between basal insulin and HDL-C (r = -0.89; p < 0.001). These data suggest that hyperinsulinemia in association with lipid abnormalities could appear early (before the development of Impaired Glucose Tolerance and Diabetes) in first degree relatives of NIDDM patients.
Assuntos
Diabetes Mellitus Tipo 2/genética , Hiperinsulinismo/epidemiologia , Hiperlipidemias/epidemiologia , Obesidade/epidemiologia , Adulto , Glicemia , Feminino , Humanos , Hiperinsulinismo/genética , Hiperlipidemias/genética , Masculino , Pessoa de Meia-Idade , Obesidade/genética , Linhagem , Análise de RegressãoRESUMO
In view of the controversy surrounding the role of environmental factors, such as the presence of bovine albumin in milk, or viral infections, in the etiology of IDDM, a study was undertaken to determine the relationship between these events and the subsequent risk of developing IDDM. On 40 venezuelan diabetic children (< 18 y) and forty, age, sex and race-matched controls were studied at the same time. Parents of children completed a questionnaire on the infant's feeding habits, its environment and family history. The X2 method and the Fischer's exact test were used to analyze the results. We found that 20% of the controls, and 10% of IDDM (NS), were never breast-fed. In 95% of controls vs 65% of IDDM (p < 0.001), cow's milk was given exclusively from birth, or combined with breast-feeding, 65% of IDDM and 60% of controls (NS) were breast-fed (alone or combined with milk substitutes) for more than three months. These results do not support the hypothesis that early exposure to breast milk substitutes increases the risk of IDDM in venezuelan children. The study revealed, however, that a family history of diabetes mellitus was present in 55% of IDDM vs 30% of controls (p < 0.05) and mumps infection before the onset of diabetes was recorded in 42.5% of IDDM in comparison with 12.5% of controls (p = 0.005). Other viral infections (rubella, chicken pox) had no statistical significance. The latter results suggest an association between a family history of diabetes mellitus and viral infections with the development of IDDM among this group of children.
Assuntos
Diabetes Mellitus Tipo 1/etiologia , Adolescente , Criança , Pré-Escolar , Meio Ambiente , Feminino , Humanos , Lactente , Masculino , VenezuelaRESUMO
Serum calcium and calcitonin were determined in 13 patients (12 women and 1 man), ages ranging from 30 to 40 years, with clinical diagnosis of hyperthyroidism due to Graves' Disease, confirmed by serum determinations of T3 and T4, with the purpose of establishing the relationship that these two substances may have in this pathology. The results obtained showed a decrease in seric calcium concentration in relation to a control group (10.02 +/-) 0.48 vs 11.49 +/- 0.28 mg/dl; p less than 0.005) and an increase in calcitonin concentration (193.6 +/- 8.62 vs 116.7 +/- 7.61 pg/ml; p less than 0.0001). We also found a significative negative association (r = -0.69; p less than 0.01) between these two compounds in the group of patients with hyperthyroidism, not being found in the control group.
Assuntos
Calcitonina/sangue , Cálcio/sangue , Doença de Graves/sangue , Hipertireoidismo/sangue , Adulto , Feminino , Doença de Graves/complicações , Humanos , Hipertireoidismo/etiologia , Hipocalcemia/etiologia , MasculinoRESUMO
With the purpose of knowing which metabolic disorders and clinical complications are more frequently developed by diabetic patients, and to analyze the relationship between the hyperglycemia state and appearance of these complications, we studied a group of patients from a Metabolic Diseases Clinic in Maracaibo, Venezuela. Fifty-four Type II diabetics patients were evaluated by means of: physical examination, anthropometric measurements, biochemical control of glycemia, insulin and lipid pattern, as well as evaluation of the complications presented. The sample consisted of 33 men and 21 women, 75% of which had glycemic values over 140 mg/dl. Basal insulin values were significantly high (29.9 +/- 8.3 uU/ml in men and 30.9 +/- 10.1 uU/ml in women) in relation to a control group (14.5 +/- 2.4 uU/ml), concluding that our diabetics presented basal hyperinsulinemia and insulin resistance. The lipid pattern of the subjects studied showed hypertriglyceridemia (70%) and hypercholesterolemia (67%). A positive association between glycemia and triglycerides values was found in the total group. HDL-cholesterol values were significantly lower in relation to the control group, obtaining a negative correlation between HDL-cholesterol and triglycerides. The clinical complications observed in these diabetics were: non-specific visuals alterations, signs of arterial illness and sensorial disorders distributed in a similar percentage (63, 61 and 51%, respectively). When the independence test X2 was applied, we obtained association (p less than 0.05) between glycemia and the frequency of complications.
Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Adulto , Idoso , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/etiologia , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/etiologia , Feminino , Humanos , Insulina/sangue , Resistência à Insulina , Lipídeos/sangue , Masculino , Pessoa de Meia-IdadeRESUMO
In order to find if the metabolic disorders more frequently found in our obese population were similar to the ones reported in the literature for other countries, a study was conducted in a group of 34 obese subjects (10 men and 24 women) whose only apparent alteration was a body mass index above 30 (mean value: 36.8 +/- 4.6) to obtain the relation between anthropometric measurements (Quetelet index, skinfold measures and waist/hip ratio) and plasma levels of nine biochemical parameters (including lipids, lipoproteins and glucose and insulin levels after an oral glucose load). The results revealed a tendency to the android distribution of fat in the female population, a significantly elevated triglyceride and total lipids levels and a decreased in HDL-cholesterol in both sexes. Hypercholesterolemia was present mainly in the male population. The most frequent dyslipidemia was Type IV (23%) followed by type IIb (15%). Practically none of the subjects had abnormal glycemic values after the glucose load, however the insulin levels were highly elevated in 80% of the patients, resulting in a great insulin/glucose ratios. Correlation analysis showed no association of the BMI with any biochemical parameter; only the insulin area was positively associated with anthropometric measures (mainly waist/hip ratio) and with the most altered biochemical parameter, the triglycerides. Variance analysis showed that only low HDL-cholesterol values were significantly different in patients presenting high blood pressure and familiar history of diabetes.