利拉鲁肽联合二甲双胍对肥胖合并2型糖尿病患者糖脂代谢、胰岛β细胞功能及体脂的影响探究

目的探讨利拉鲁肽联合二甲双胍对肥胖合并2型糖尿病患者糖脂代谢、胰岛β细胞功能及体脂的影响。 方法选择成都市郫都区第二人民医院2017年1月至2018年12月收治的肥胖合并2型糖尿病患者141例作为研究对象,按照随机数字表法分为利拉鲁肽组47例、二甲双胍组47例与联合组47例。利拉鲁肽组采用利拉鲁肽治疗,二甲双胍组采用二甲双胍治疗,联合组采用利拉鲁肽联合二甲双胍治疗。三组疗程均为3个月。比较三组治疗前后糖代谢、脂代谢、胰岛β细胞功能和体重指数（BMI）变化,及不良反应,治疗前后比较采用配对t检验,三组间比较采用F检验,两组间比较采用LSD-t检验。 结果三组治疗后FPG、HbA1c和2hPG水平较治疗前降低,差异具有统计学意义（P均< 0.05）;联合组治疗后FPG（6.57±0.39）?mmol/L、HbA1c（7.03±0.42）%和2hPG（8.78±0.45）mmol/L低于利拉鲁肽组（7.03±0.32）mmol/ L、（7.68±0.35）%、（9.56±0.65）mmol/L（t = 6.251、8.151、6.764,P均?< 0.05）和二甲双胍组（7.06±0.39）mmol/L、（7.76±0.46）%、（9.70±0.81）?mmol/L,差异具有统计学意义（t = 6.091、8.034、6.807,P均< 0.05）。三组治疗后HDL-C水平较治疗前升高,而TC、LDL-C和TG水平较治疗前降低,差异具有统计学意义（P均< 0.05）;联合组治疗后HDL-C （1.56±0.13） mmol/ L高于利拉鲁肽组（1.29±0.14） mmol/ L（t = 9.689,P < 0.05）和二甲双胍组（1.32±0.15） mmol/ L,差异具有统计学意义（t = 8.289,P < 0.05）;而联合组TC（4.35±0.38） mmol/L、LDL-C（2.79±0.21）mmol/L和TG（2.15±0.26） mmol/ L低于利拉鲁肽组（5.18±0.43）mmol/L、（3.19±0.15）mmol/L、（2.65±0.17） mmol/L（t = 9.916、10.626、11.035,P < 0.05）和二甲双胍组（5.15±0.34）mmol/L、（3.23±0.25）mmol/ L、（2.68±0.23） mmol/ L,差异具有统计学意义（t = 10.756、9.239、10.467,P均< 0.05）。三组治疗后HOMA-β较治疗前升高,差异具有统计学意义（P < 0.05）;联合组治疗后HOMA-β（4.87±0.28）高于利拉鲁肽组（4.15±0.36）和二甲双胍组（4.08±0.41）,差异具有统计学意义（t = 10.823,10.909,P均< 0.05）。三组治疗后BMI较治疗前降低,差异具有统计学意义（P < 0.05）;联合组治疗后BMI （28.08±0.37）kg/m²低于利拉鲁肽组（29.73±0.49）kg/m²和二甲双胍组（29.61±0.43）kg/m²,差异具有统计学意义（t = 18.423,18.490,P均< 0.05）。 结论利拉鲁肽联合二甲双胍对肥胖合并2型糖尿病患者效果良好,可改善患者糖脂代谢和胰岛β细胞功能,降低体质指数,值得临床借鉴。     

2型糖尿病伴冠心病患者肠道菌群分布及其与糖、脂代谢指标的相关性

探讨2型糖尿病伴冠心病患者肠道菌群分布及其与糖、脂代谢指标的关系,为该类患者的治疗提供参考。

选取2021年1月至2021年12月我院收治的2型糖尿病伴冠心病患者50例作为试验组,选择50例同期在我院体检的健康人作为对照组,比较2组对象基本资料、肠道菌群分布（肠杆菌、肠球菌、双歧杆菌、拟杆菌、乳杆菌）、糖代谢指标[空腹血糖（FPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）]水平、脂代谢指标[甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）]水平,分析肠道菌群分布与糖、脂代谢指标的相关性。

2组对象年龄、性别、体质量指数、收缩压、舒张压、吸烟史、高血压史比较差异均无统计学意义（均P＞0.05）。试验组患者肠道肠杆菌、肠球菌数量均高于对照组,双歧杆菌、拟杆菌、乳杆菌数量均低于对照组（均P＜0.05）。试验组患者FPG、FINS、血清HbA1c水平均高于对照组（均P＜0.05）。试验组患者血清TC、TG、LDL-C水平均高于对照组,而血清HDL-C水平低于对照组（均P＜0.05）。试验组患者肠道肠杆菌、肠球菌与FPG、HbA1c、FINS、TC、TG、LDL-C水平均呈正相关,与HDL-C均呈负相关（均P＜0.05）;而肠道双歧杆菌、拟杆菌、乳杆菌与FPG、HbA1c、FINS、TC、TG、LDL-C均呈负相关,与HDL-C均呈正相关（均P＜0.05）。

2型糖尿病伴冠心病患者肠道肠杆菌、肠球菌数量升高,双歧杆菌、拟杆菌、乳杆菌数量降低,且肠道菌群数量与糖、脂代谢指标具有显著相关性。

     

低碳水化合物饮食对2型糖尿病患者糖代谢的改善作用

探讨低碳水化合物饮食对2型糖尿病（T2DM）患者肠道微生物和空腹高血糖的影响。

选择2019年5月至2019年8月我院内分泌科招募的100例T2DM患者为研究对象,患者随机分配到干预饮食组（LCD组,低碳水化合物饮食）或控制饮食组（LFD组）。LFD组患者的饮食为500 g蔬菜/d,100 g主食/餐（300 g/d）,3汤匙油/d,两餐之间提供稳定血糖、低血糖指数水果,5种蛋白质（220 mL牛奶、1个鸡蛋、100 g鱼虾、50 g大豆、50 g肉）/d,6 g盐/ d。LCD组每天摄入杏仁56 g以取代150 g/d富含碳水化合物的主食,其余饮食方案与LFD组相同。收集所有参与者的粪便标本,取豌豆大小的粪便置入1.5 mL的试管中,立即于−80 ℃保存。使用QIAAMP^® DNA粪便抽提试剂盒进行粪便样本的总DNA提取,随后进行16S rRNA基因测序,对其菌群进行分析。

LCD组患者肠道微生物群Shannon指数,Chao指数和Simpson指数显著高于LFD组（均P＜0.05）。两组患者按照规定饮食3个月后肠道微生物组检测显示,总共有9个门,其中排名前5位的细菌门约占所有细菌的96.00%。LCD组患者以拟杆菌门为主（72.32%）,其次为假单胞菌门（13.81%）、变形菌门（8.22%）、梭杆菌门（0.03%）、放线菌门（0.63%）。LFD组患者肠道菌群门水平的细菌组成与LCD组相近。其中,LFD组梭杆菌门丰度（0.35%）高于LCD组（0.03%）。同时,LCD组产单链脂肪酸细菌（Roseburis）和瘤胃球菌的相对丰度升高。两组之间3种主要营养素的总能量和热量比例差异无统计学意义（均P＞0.05）。干预3个月时,两组患者的总能量差异无统计学意义（P＞0.05）。与LFD组相比,LCD组患者来自碳水化合物的热量减少,而来自脂肪的热量显著增加（均P＜0.05）。此外,干预后,LCD组患者中有40%来自碳水化合物的热量达到LCD标准,而LFD组患者中有25%来自脂肪的热量达到LFD标准。治疗3个月时,LCD组患者HbA1c下降幅度大于LFD组（P＜0.05）。干预期间,LCD组有3例、LFD组有5例患者降糖药物使用量减少,其余受试者无显著变化。

低碳水化合物饮食可能通过改善T2DM患者肠道菌群区系进一步改善患者的糖代谢。

     

青春双歧杆菌对2型糖尿病模型大鼠肠道菌群和脂质代谢的影响

目的通过观察青春双歧杆菌对2型糖尿病模型大鼠肠道菌群的变化,和血清中总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL-C）、超氧化物歧化酶（SOD）和丙二醛（MDA）的水平,探讨青春双歧杆菌对2型糖尿病模型大鼠肠道功能和脂质代谢的影响。方法采用青春双歧杆菌灌胃2型糖尿病模型大鼠,取粪便检查正常菌群,取血和脏器检测TC、TG、HDL-C、SOD和MDA含量。结果青春双歧杆菌导致肠道内双歧杆菌、乳杆菌的数量增加,而肠杆菌、肠球菌数量下降;TC、TG和MDA水平下降,而HDL-C和SOD水平升高。结论青春双歧杆菌具有改善2型糖尿病模型大鼠肠道功能和降血脂作用,与二甲双胍联合应用效果更佳。     

利拉鲁肽联合二甲双胍对2型糖尿病合并肥胖患者胰岛β细胞功能以及内脏脂肪水平的影响

目的分析利拉鲁肽联合二甲双胍对2型糖尿病（T2DM）合并肥胖患者胰岛β细胞功能以及内脏脂肪水平的影响。 方法选取重庆两江新区第一人民医院2016年3月至2018年3月收治的194例T2DM合并肥胖患者,将其随机分为研究组、对照组,各97例,均给予为期16周的二甲双胍治疗,研究组加用利拉鲁肽皮下注射。比较两组患者治疗前后血糖、胰岛β细胞功能指数（HOMA-β）、内脏脂肪水平（VFL）等指标变化,总结利拉鲁肽在T2DM合并肥胖治疗中的临床价值。计数资料采用卡方检验,计量资料采用t检验。 结果研究组不良反应发生率为29.90﹪,对照组为23.71﹪,组间比较差异无统计学意义（χ²= 0.946,P > 0.05）。两组患者治疗后FPG、2 hPG、BMI均较治疗前下降,研究组治疗后FPG、2 hPG、BMI分别为（7.12±1.35）?mmol/?L、（9.03±2.66）?mmol/L、（26.32±1.60）kg/m²,均低于对照组的（7.83± 1.19）?mmol/L、（10.57±2.39）?mmol/?L、（27.74±1.66）kg/m²,差异有统计学意义（t = 3.886、4.241、6.066,P均?< 0.05）。两组患者治疗后HOMA-β较治疗前升高,HOMA-IR较治疗前下降,研究组治疗后HOMA-β为155.69±24.55,高于对照组的117.49±21.98,其HOMA-IR为2.30±0.71,低于后者的3.20±0.64,差异有统计学意义（t = 11.407、9.273,P均< 0.05）。两组患者治疗后VFL、脂肪率均较治疗前下降,研究组治疗后VFL、脂肪率低于对照组,且其治疗后肌肉含量较治疗前下降,差异有统计学意义（P < 0.05）。 结论在二甲双胍的基础上联合利拉鲁肽能够通过改善胰岛β细胞功能、减少内脏脂肪,达到改善T2DM合并肥胖患者的胰岛素抵抗的目的,是一种安全、有效的治疗方案。     

Tenomodulin is associated with obesity and diabetes risk: the Finnish diabetes prevention study

We recently showed that long-term weight reduction changes the gene expression profile of adipose tissue in overweight individuals with impaired glucose tolerance (IGT). One of the responding genes was X-chromosomal tenomodulin (TNMD), a putative angiogenesis inhibitor. Our aim was to study the associations of individual single nucleotide polymorphisms and haplotypes with adiposity, glucose metabolism, and the risk of type 2 diabetes (T2D). Seven single nucleotide polymorphisms from two different haploblocks were genotyped from 507 participants of the Finnish Diabetes Prevention Study (DPS). Sex-specific genotype effects were observed. Three markers of haploblock 1 were associated with features of adiposity in women (rs5966709, rs4828037) and men (rs11798018). Markers rs2073163 and rs1155794 from haploblock 2 were associated with 2-hour plasma glucose levels in men during the 3-year follow-up. The same two markers together with rs2073162 associated with the conversion of IGT to T2D in men. The risk of developing T2D was approximately 2-fold in individuals with genotypes associated with higher 2-hour plasma glucose levels; the hazard ratios were 2.192 (p = 0.025) for rs2073162-A, 2.191 (p = 0.027) for rs2073163-C, and 1.998 (p = 0.054) for rs1155974-T. These results suggest that TNMD polymorphisms are associated with adiposity and also with glucose metabolism and conversion from IGT to T2D in men.     

The variant at TGFBRAP1 is significantly associated with type 2 diabetes mellitus and affects diabetes‐related miRNA expression

While the transforming growth factor‐β1 (TGF‐β1) regulates the growth and proliferation of pancreatic β‐cells, its receptors trigger the activation of Smad network and subsequently induce the insulin resistance. A case‐control was conducted to evaluate the associations of the polymorphisms of TGF‐β1 receptor‐associated protein 1 (TGFBRAP1) and TGF‐β1 receptor 2 (TGFBR2) with type 2 diabetes mellitus (T2DM), and its genetic effects on diabetes‐related miRNA expression. miRNA microarray chip was used to screen T2DM‐related miRNA and 15 differential expressed miRNAs were further validated in 75 T2DM and 75 normal glucose tolerance (NGT). The variation of rs2241797 (T/C) at TGFBRAP1 showed significant association with T2DM in case‐control study, and the OR (95% CI) of dominant model for cumulative effects was 1.204 (1.060‐1.370), Bonferroni corrected P < 0.05. Significant differences in the fast glucose and HOMA‐β indices were observed amongst the genotypes of rs2241797. The expression of has‐miR‐30b‐5p and has‐miR‐93‐5p was linearly increased across TT, TC, and CC genotypes of rs2241797 in NGT, P_trend values were 0.024 and 0.016, respectively. Our findings suggest that genetic polymorphisms of TGFBRAP1 may contribute to the genetic susceptibility of T2DM by mediating diabetes‐related miRNA expression.     

Comparative understanding of UTS2 and UTS2R genes for their involvement in type 2 diabetes mellitus

Several reports have shown that urotensin 2 (UTS2) and its receptor (UTS2R) are involved in glucose metabolism and insulin resistance, which lead to development of type 2 diabetes mellitus (T2DM) in humans. In the present study, we annotated both bovine UTS2 and UTS2R genes and identified 5 single nucleotide polymorphisms (SNPs) for the former gene and 14 mutations for the latter gene. Four mutations were genotyped on a Wagyu x Limousin reference population, including 6 F₁ bulls, 113 F₁ dams and ~250 F₂ progeny. Among 12 phenotypes related to fat deposition and fatty acid composition, we observed that the UTS2 gene was significantly associated with the amount of skeletal saturated fatty acids, while its receptor (UTS2R) gene had significant effects on amounts of saturated and monounsaturated fatty acids, Δ⁹ desaturase activity for converting 16:0 into 16:1, muscle fat (marbling) score and Longissimus Dorsi muscle area. However, in this population, these markers were not associated with subcutaneous fat depth or percent kidney, pelvic and heart fat. We also found that mutations in the promoter regions altered the promoter activities in both genes and coding SNPs might affect the mRNA stability in the UTS2R gene. Overall, our present study provides the first evidence that both UTS2 and UTS2R genes regulate skeletal muscle fat accumulation and fatty acid metabolism, thus indicating their potential pathological functions related to obesity and T2DM in humans.     

硫氧还蛋白结合蛋白-2在糖和脂代谢中的作用

硫氧还蛋白结合蛋白-2(thioredoxin binding protein-2,TBP-2)属于硫氧还蛋白结合蛋白家族成员,与还原型硫氧还蛋白结合,抑制其还原活性。在生物体内,TBP-2不但参与细胞内的氧化还原调节,还具有调节细胞生长繁殖和促进细胞凋亡的作用。TBP-2在葡萄糖和脂肪代谢中的作用被广泛研究。TBP-2高表达时,胰岛细胞凋亡,与糖尿病发生相关;而TBP-2缺失,与高脂血症发病有关。本文综述了TBP-2在糖脂代谢中的作用。     

Implication of SH2B1 gene polymorphism studies in gestational diabetes mellitus in Saudi pregnant women

Genome-wide association studies have identified loci that are firmly associated with obesity. The Src-homology-2 B adaptor protein 1 (SH2B1) loci is abundantly expressed in the brain, liver, heart, muscle, and fat tissues. Gestational diabetes mellitus (GDM) is a growing health concern that usually appears during the latter half of pregnancy, and it is characterized by carbohydrate intolerance of variable severity. The SH2B1 gene polymorphism has been linked with an increased risk of weight gain in several but not all population studies. This study aimed to investigate the genetic association of rs4788102 variants in the SH2B1 gene with GDM in Saudi pregnant women. Genomic DNA samples from 200 women with GDM and 300 women without GDM were genotyped using the TaqMan method. The distribution of the GG, GA, and AA genotypes was significantly different between GDM and non-GDM women (p < 0.05). Thus, we identified rs4788102 variants as additional risk factors for GDM in Saudi women, and we suggest that these variants may have a prognostic value.     

Assessment of gender-related differences in vitamin D levels and cardiovascular risk factors in Saudi patients with type 2 diabetes mellitus

Diabetes is a major risk factor for cardiovascular disease (CVD) including stroke, coronary heart disease, and peripheral artery disease. It remains a leading cause of mortality throughout the world, affecting both women and men. This investigation was aimed to study gender based differences in cardiovascular risk factors of adult population with type-2 diabetes mellitus (T2DM) and to check the correlation between serum HbA1C, lipid profile and serum vitamin D levels, in T2DM patients of Riyadh, Saudi Arabia. This hospital-based cross-sectional study involving subjects was divided into two gender based groups; normal male (800), diabetic male (800) and normal female (800) and T2DM females (800). Blood samples were analyzed for fasting glucose (FBG), HbA1c, total cholesterol (TC), triglycerides (Tg), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and serum levels of 25(OH)-vitamin D in all groups. All the glycemic control parameters and lipid profile parameters were found to be significantly different in diabetic vs non-diabetic group (p < 0.001) in both genders. The results also show that vitamin D concentration decreased significantly (p < 0.001) in diabetic patients than the healthy individuals in both the genders. Vitamin-D and HbA1C were negatively correlated in both males and females in T2DM patients and significant at P < 0.05. Our study reveals that dyslipidemia remains one of the major risk factors of CVD in T2DM. In addition to dyslipidemia, decreased levels of vitamin-D associated with increased HbA1C alarms the early diagnosis of Type 2 Diabetes.     

磺酰脲受体1基因多态性与2型糖尿病的相关性

目的：研究磺酰脲受体1（sulfonylurea receptorl,SUR1）基因外显子16-3c／t多态性与湖北汉族人群2型糖尿病的相关性。方法：采用同胞对（2型糖尿病人及其正常同胞）和随机病例一对照两种实验设计,应用PCR-RFLP方法分析共405个样本的SUR1基因外显子16-3c／t多态性,并测定身高、体重、腰围、臀围、血压、空腹血糖等生理生化指标。结果：两种实验设计中病例组与对照组的基因型和等位基因频率均无显著性差异（P〉0．05）。结论：在湖北汉族人群中未发现SUR1基因外显子16-3c／t多态性与2型糖尿病之间存在关联,该基因座可能不是该人群的致病基因。     

Variant rs2237892 of KCNQ1 Is Potentially Associated with Hypertension and Macrovascular Complications in Type 2 Diabetes Mellitus in A Chinese Han Population

KCNQ1 has been identified as a susceptibility gene of type 2 diabetes mellitus(T2DM) in Asian populations through genome-wide association studies. However, studies on the association between gene polymorphism of KCNQ1 and T2 DM complications remain unclear. To further analyze the association between different alleles at the single nucleotide polymorphism(SNP) rs2237892 within KCNQ1 and TD2 M and its complications, we conducted a case-control study in a Chinese Han population. The C allele of rs2237892 variant contributed to susceptibility to T2DM(odds ratio [OR], 1.45; 95% confidence interval [CI], 1.20–1.75). Genotypes CT(OR, 1.97; 95% CI,1.24–3.15) and CC(OR, 2.49; 95% CI, 1.57–3.95) were associated with an increased risk of T2 DM. Multivariate regression analysis was performed with adjustment of age, gender, and body mass index. We found that systolic blood pressure(P = 0.015), prevalence of hypertension(P = 0.037), and risk of macrovascular disease(OR, 2.10; CI, 1.00–4.45) were significantly higher in subjects with the CC genotype than in the combined population with genotype either CT or     

Association of polymorphic markers of the lipid metabolism genes with diabetic polyneuropathy in type 1 diabetes mellitus

A possible association of the polymorphic markers 2/3/4 of the apolipoprotein E gene (APOE) and I /D of the apolipoprotein B gene (APOB) with diabetic polyneuropathy (DPN) was analyzed in patients with type 1 diabetes mellitus (T1DM) with (N=86) or without (N=94) clinical signs of DPN. The two groups did not differ significantly in allele and genotype frequencies of the 2/3/4 polymorphic marker of the APOE gene. Analysis of the allele and genotype frequency distributions of the I/D polymorphic marker of the APOB gene showed that risk of DPN is higher in carriers of allele I or genotype I/I (OR=1.66 and 2.01, respectively) and lower in carriers of allele D (OR=0.60). The results implicate the APOB gene, which codes for one of the major components of the lipid metabolism system, in DPN development in patients with T1DM.__________Translated from Molekulyarnaya Biologiya, Vol. 39, No. 2, 2005, pp. 230–234.Original Russian Text Copyright © 2005 by Voronko, Yakunina, Strokov, Lavrova, Nosikov.     

Androgen receptor: a new player associated with apoptosis and proliferation of pancreatic beta-cell in type 1 diabetes mellitus

Androgen receptor (AR) mediates a wide range of cellular processes, such as proliferation, differentiation and apoptosis. Here we sought to identify whether AR was located in pancreatic beta-cells and investigate its functions in type 1 diabetes induced by multiple low doses of streptozotocin. Double/triple immunofluorescence, Western blot and semi-quantitative RT-PCR were carried out to determine variances of AR expression in beta-cells and correlation between AR and apoptosis/proliferation of beta-cells with progress of diabetes. In addition, in vitro primary beta-cells from control mice were cultured for 3 days or 6 days with compound stimulation in order to further identify effect of AR on beta-cell apoptosis and proliferation. AR expression in beta-cells peaked in control and 1-day diabetic mice, gradually and significantly decreased, even disappeared in diabetic mice with progress of diabetes. TUNEL-positive beta-cells were concomitant with overexpression of AR, and Ki67-positive beta-cells showed extremely weak, even negative AR staining. In vitro, AR could mediate beta-cell apoptosis, and AR antagonist flutamide contributed to beta-cell proliferation. In conclusion, AR is abundantly expressed in pancreatic beta-cell cytoplasm of control mice. With progress of type 1 diabetes, decrement of AR expression in diabetic mice contributes to prohibit beta-cells from apoptosis, and is strongly associated with beta-cell proliferation.     

C-aryl glucosides substituted at the 4'-position as potent and selective renal sodium-dependent glucose co-transporter 2 (SGLT2) inhibitors for the treatment of type 2 diabetes

A series of C-aryl glucosides with various substituents at the 4′-position of the distal aryl ring have been synthesized and evaluated for inhibition of hSGLT1 and hSGLT2. Introduction of alkyl or alkoxy substituents at the 4′-position was found to improve SGLT2 potency, whereas introduction of a hydrophilic group at this position was deleterious. Compounds with alkoxy-, cycloalkoxy- or cycloalkenyloxy-ethoxy scaffolds exhibited good inhibitory activity and high selectivity toward SGLT2. Selected compounds were investigated for in vivo efficacy.     

Beta-cell dysfunctions and insulin resistance in subjects with increased risk for type 2 diabetes mellitus

The aim of this study was to test if a beta-cell defect is associated to deterioration of glucose tolerance early during the natural history of the type 2 diabetes mellitus . In 41 overweight women, with macrosomic infants in their antecedent deliveries, measures of insulin response and insulin sensitivity were derived from a short (45 min) iv glucose test. The early (EIR) and the late (LIR) phase insulin responses and the insulin sensitivity index (Si) were calculated. According the response to 75 g oral glucose test the subjects were divided into two groups: Imparired glucose tolerance (IGT;n = 12), and normal glucose tolerance (NGT; n = 29). EIR was reduced in IGT group (14.9 ± 3.6 vs 37.0 ± 4.0; p< 0.002). Glucose tolerance during oral glucose tolerance test (OGTT), correlated inversly to EIR (r=-0.45; n=41; p< 0.01). A strong correlation of EIR to LIR (r=0.88; n = 41; p< 0.001) but no correlation between glucose tolerance and Si was found.