Activated hypothalamic pituitary adrenal axis in patients with metabolic syndrome

Metabolic syndrome (MetS) is correlated with the activity of hypothalamic-pituitary-adrenal axis (HPA), but the underlying mechanism still remains elusive. The aim of this study was to investigate the HPA axis function in patients with MetS. This case-control study included 159 people. They were divided into 2 groups. The first group included 73 healthy volunteers (control group: 19 males, 54 females, mean±SD: 49.9±7.5 years old, with BMI: 27.9±4.42?kg/m2) and the second group included 86 patients with MetS (case group: 48 males, 38 females, mean±SD: 52.2±7.6 years old, with BMI: 30.5±5.35?kg/m2). An oral glucose tolerance test (OGTT) was performed for all subjects after a 12-h overnight fast, and blood samples were obtained for determination of ACTH, cortisol, insulin, C-peptide, and glucose levels. Serum cortisol after an overnight dexamethasone suppression test was determined in both groups. Patients with MetS had serum cortisol levels after an overnight dexamethasone suppression test significantly higher than controls. During OGTT plasma ACTH levels were higher at all time points in patients with MetS compared to controls, whereas serum cortisol levels were comparable between the 2 groups. Plasma ACTH during OGTT was also correlated with most of the components of MetS. The HPA axis in patients with MetS seems to be more active as evidenced by the higher cortisol levels after the overnight dexamethasone suppression test and by the higher ACTH levels during OGTT. This functional hypercortisolism might be involved in the pathogenesis of the metabolic syndrome.     

The possibility of prevention of type 2 diabetes

INTRODUCTION: The aim of this study was to examine usefulness of oral glucose tolerance test (OGTT) in clinical evaluation of different glucose metabolism disturbances in subjects with at least one risk factor of type 2 diabetes. We compared the effectiveness of non-pharmacological and pharmacological prevention and treatment regiments on metabolic control in these individuals. MATERIAL AND METHODS: The study involved 130 patients, with the following characteristics: age between 18 to 76 years, mean body mass index (BMI) - 31.82 +/- 7.24 kg/m(2), and presence of at least one of the risk factor of type 2 diabetes. Glucose metabolism disturbances were diagnosed according to World Health Organization (WHO) criteria. Non-pharmacological regiments were applied for 3 months for patients with impaired glucose tolerance (IGT) and type 2 diabetes. Patients, whose still met criteria for type 2 diabetes during OGTT after non-pharmacological treatment were scheduled for pharmacological interventions. These patients were assigned at random to two groups, that were treated with either metformin or acarbose. The measurements of total cholesterol (TC), HDL-cholesterol , LDL-cholesterol, trigliceryde (TG), glucose, HbA(1c) and/or OGGT were performed during each visit. We also assessed risk factors for type 2 diabetes in these subjects. RESULTS: The prevalence of abnormal glucose tolerance in subjects with at least one of the risk factor of diabetes type 2 was near 40%. OGTT in these subjects increased the possibility of diagnosis diabetes type 2 and IGT. Hypertension (81%), hypercholesterolemia (71.4%), hypertriglicerydemia (71.4%) and obesity (66.7%) were the most frequent risk factors observed. There were no differences in biochemical measurements between these groups of patients. CONCLUSIONS: Individuals with at least one risk factor of type 2 diabetes should have screening test to diagnose glucose intolerance. Both non-pharmacological and pharmacological intervention was effective in normalization of glucose OGTT in patients with diabetes type 2 and IGT in newly diagnosed with disease patients.     

Continuous glucose monitoring in cystic fibrosis patients according to the glucose tolerance.

Cystic fibrosis (CF) is associated with a long preclinical state of abnormal glucose tolerance. The aim of this study was (i) to evaluate the profile of glucose tolerance in young adults with CF and (ii) to compare these results with those obtained by a continuous subcutaneous glucose monitoring (CGMS). CF subjects with fasting glycemia inferior to 126 mg/dl were included in the study. An oral glucose tolerance test (OGTT) identified the subjects either with a normal glucose tolerance (NGT), or impaired glucose tolerance (IGT), or diabetes. CGMS (Medtronic) was performed during 3 days to analyze mean glucose level, high glucose excursions, and glucose area under the curve (AUC). Forty-nine patients were included in the study. NGT (n=22), IGT (n=17), and diabetes groups (n=10) were comparable except with regard to age and BMI (p<0.001). HbA1c values in diabetes group were significantly higher (p<0.001) than in NGT and IGT groups. CGMS revealed peaks of glucose values superior to 200 mg/dl at least once after a meal in 8 patients (36%) with NGT, in 9 patients (52%) with IGT, and in all patients with diabetes (p<0.01). Mean CGMS glucose and glucose AUC values increased in patients with diabetes compared to patients with NGT and IGT (p<0.05). Peak of CGMS glucose reached 182+/-60 mg/dl in NGT group despite the normal glucose profile at OGTT. In conclusion, CGMS revealed pathological glucose excursions not only in patients with impaired glucose tolerance at OGTT but also in patients with a normal glycemic profile. CGMS could be a useful tool for the early detection of hyperglycemia in patients with CF.     

Analysis of Fasting Plasma Glucose Values for Optimal Detection of Abnormal Responses on the Oral Glucose Tolerance Test in at-Risk Study Subjects

ObjectiveTo identify the fasting plasma glucose (FPG) value with the best performance for detecting an abnormal response on the oral glucose tolerance test (OGTT) in patients at risk for having type 2 diabetes.MethodsAll patients who underwent a 2-hour OGTT during an 18-month period were included in this study. Pretest and posttest odds, likelihood ratios, and receiver operating characteristic curves were used to identify the FPG value most strongly associated with an abnormal result on the OGTT (either diabetes or impaired glucose tolerance [IGT]).ResultsOf the 1,371 patients who underwent an OGTT during the designated study period, 1,239 fulfilled the inclusion criteria. The prevalence of IGT was 25.34% (314 patients). Diabetes was diagnosed in 141 patients (11.38%). IGT was more commonly found in the FPG strata below 115 mg/dL; above this value, diabetes was more frequently diagnosed. In general, the percentage of cases of IGT increased progressively throughout the “normal” FPG range. The prevalence varied from 11.4% (in patients with FPG values < 80 mg/dL) to 32% (in those with FPG levels from 95 to 99.9 mg/dL). FPG values between 95 and 99.9 mg/dL had a likelihood ratio of 2.1 for detecting an abnormal OGTT response, of 1.8 for detecting diabetes, and of 1.66 for detecting IGT. The odds ratio for detecting either IGT or diabetes was increased 2-fold by performing an OGTT. The FPG threshold with the best ability for detecting an abnormal response on the OGTT was 95 mg/dL (sensitivity of 0.72 and specificity of 0.65).ConclusionIn patients at risk for type 2 diabetes, the FPG cut point (95 mg/dL) most useful for detecting an abnormal OGTT response is included in the normal range of the FPG. (Endocr Pract. 2007;13:583-589)     

二甲双胍联合炔雌醇环丙孕酮片治疗对多囊卵巢综合征患者临床疗效及糖脂代谢的影响

摘要 目的：研究二甲双胍联合炔雌醇环丙孕酮片治疗多囊卵巢综合征（polycystic ovarian syndrome,PCOS）患者的临床疗效及对患者糖脂代谢的影响。方法：选取2018年1月~2020年12月在我院接受治疗的60例PCOS患者作为研究对象,随机数表法均分为对照组和研究组：对照组患者接受炔雌醇环丙孕酮片治疗,而研究组患者接受二甲双胍联合炔雌醇环丙孕酮片治疗。比较两组患者治疗后排卵和妊娠情况,并比较治疗前后性激素水平和糖脂代谢的变化。结果：研究组治疗总有效率为83.33%,显著高于对照组63.33%的治疗总有效率（P<0.05）。治疗前,两组患者血清卵泡刺激素（Follicle Stimulating Hormone, FSH）、黄体生成素（Luteinizing hormone, LH）、雌二醇（Estradiol, E2）、睾酮（Testosterone, T）等性激素水平,空腹血糖（fasting plasma glucose, FPG）、空腹胰岛素（Fasting serum lisulin, FINS）、口服葡萄糖耐量试验（oral glucose tolerance test, OGTT）2 h血糖和胰岛素等糖代谢指标以及甘油三酯（Triglycerides, TG）、胆固醇（Total cholesterol, TC）、高密度脂蛋白（High density lipoprotein, HDL）和低密度脂蛋白（Low density lipoprotein, LDL）等脂代谢指标脂代谢指标比较均无显著差异（P>0.05）;治疗后,所有患者血清FSH、LH、T、E2、TG、LDL、TC、FPG、FINS、OGTT 2h PG和OGTT 2h INS均较治疗前显著降低（P<0.05）,而HDL较治疗前升高（P<0.05）;研究组患者治疗后血清FSH、LH、T、E2、TG、LDL、TC、FPG、FINS、OGTT 2h PG和OGTT 2h INS均较显著低于对照组患者（P<0.05）,而HDL显著高于对照组患者（P<0.05）。结论：二甲双胍联合炔雌醇环丙孕酮片治疗多囊卵巢综合征临床效果显著,可有效改善患者糖脂代谢水平。     

Thiazolidinediones improve beta-cell function in type 2 diabetic patients

Thiazolidinediones (TZDs) improve glycemic control and insulin sensitivity in patients with type 2 diabetes mellitus (T2DM). There is growing evidence from in vivo and in vitro studies that TZDs improve pancreatic beta-cell function. The aim of this study was to determine whether TZD-induced improvement in glycemic control is associated with improved beta-cell function. We studied 11 normal glucose-tolerant and 53 T2DM subjects [age 53+/-2 yr; BMI 29.4+/-0.8 kg/m2; fasting plasma glucose (FPG) 10.3+/-0.4 mM; Hb A1c 8.2+/-0.3%]. Diabetic patients were randomized to receive placebo or TZD for 4 mo. Subjects received 1) 2-h OGTT with determination of plasma glucose, insulin, and C-peptide concentrations and 2) two-step euglycemic insulin (40 and 160 mU.m-2.min-1) clamp with [3-(3)H]glucose. T2DM patients were then randomized to receive 4 mo of treatment with pioglitazone (45 mg/day), rosiglitazone (8 mg/day), or placebo. Pioglitazone and rosiglitazone similarly improved FPG, mean plasma glucose during OGTT, Hb A1c, and insulin-mediated total body glucose disposal (Rd) and decreased mean plasma FFA during OGTT (all P<0.01, ANOVA). The insulin secretion/insulin resistance (disposition) index [DeltaISR(AUC)/Deltaglucose(AUC)/IR] was significantly improved in all TZD-treated groups: +1.8+/-0.7 (PIO+drug-na?ve diabetics), +0.7+/-0.3 (PIO+sulfonylurea-treated diabetics), and 0.7+/-0.2 (ROSI+sulfonylurea-withdrawn diabetics) vs. -0.2+/-0.3 in the two placebo groups (P<0.01, all TZDs vs. placebo, ANOVA). Improved insulin secretion correlated positively with increased body weight, fat mass, and Rd and inversely with decreased plasma glucose and FFA during the OGTT. In T2DM patients, TZD treatment leads to improved beta-cell function, which correlates strongly with improved glycemic control.     

The effect of oral glucose tolerance testing on changes in arterial stiffness and blood pressure in elderly women with hypertension and relationships between the stage of diabetes and physical fitness levels

[Purpose] The purpose of this study was to assess changes in blood glucose level, blood pressure, and arterial stiffness after a 75 g oral glucose tolerance test (OGTT) in elderly women aged over 65 years with hypertension and either normal glycemic control, impaired fasting glucose tolerance, or diabetes mellitus. We also wished to investigate the relationship between stages of diabetes and physical fitness.[Methods] A total of 24 elderly women with hypertension were assigned to a control group (CON; n=7), impaired fasting glucose group (IFG; n=9), and diabetes mellitus group (DM; n=8). In each group, blood glucose level, brachial ankle pulse wave velocity (PWV), and blood pressure were measured at baseline as well as 60 and 120 minutes after a 75 g OGTT. Physical fitness factors such as hand grip strength, balance test, 4 m gait speed test, chair stand test, short physical performance battery, and 6-minute walking test were subsequently assessed.[Results] In all three groups, blood glucose levels were significantly increased at 60 and 120 minutes after a 75 g OGTT. In the DM group, blood glucose levels were significantly higher before and after a 75 g OGTT than in the CON group. In the CON group, PWV was significantly increased at 60 minutes after a 75 g OGTT; however, there were no changes in other groups after glucose ingestion. In the CON group, systolic and diastolic blood pressures were significantly decreased at 60 and 120 minutes after a 75 g OGTT compared to baseline. However, there was no change in blood pressure after ingestion in the DM group. The IFG group had greater grip strength than the CON group; however, there were no differences in other variables between the groups.[Conclusion] After a 75 g OGTT, elderly women with hypertension and diabetes maintain higher blood glucose levels compared to those with hypertension alone. Unlike elderly women with hypertension alone, those with hypertension and diabetes did not show changes in arterial stiffness and blood pressure after a 75 g OGTT. Therefore, elderly women with hypertension and diabetes may not be able to control their blood vessels following a 75 g OGTT due to impaired vascular endothelial function. Moreover, there was no association between diabetes stage and physical fitness in elderly women with hypertension.     

Behavior of C-peptide and immunoreactive insulin in essential obesity]

The levels of glucose, immunoreactive insulin and C-peptide were studied in 13 obese patients and 10 control subjects, in basal conditions and after an oral glucose load (OGTT). The IRI and C-peptide levels were higher in the obese patients than in the controls either during fasting or during the OGTT. The C-peptide/IRI ratio decreased after the oral glucose load in both groups studied. However in the obese subjects the values for the C-peptide/IRI ratio were lower than those found in the controls during the same observation period. These results suggest the hypothesis that in the obese patients the high IRI levels which reflect an increased insulin secretion, are, at least in part, due to an early saturation of the hepatic degradation of insulin and/or to a decrease in the specific receptor sites normally present in the cell membranes.     

On the Status and Comparison of Glucose Intolerance in Female Breast Cancer Patients at Initial Diagnosis and during Chemotherapy through an Oral Glucose Tolerance Test

Aims

This study is to estimate the status and comparison of glucose intolerance in female breast cancer patients at initial diagnosis and during chemotherapy through an oral glucose tolerance test (OGTT), as well as to learn the effect of chemotherapy on the glucose metabolism of breast cancer patients.

Methods

All the 79 breast cancer patients at initial diagnosis, with the mean age of 53.2 years, and 96 breast cancer patients before the 5th or 6th cycle of chemotherapy, with the mean age of 51.5 years, participated in the study from December 2012 to October 2013. After an overnight fast, participants underwent OGTT test, and fasting and 2-hour glucose levels were measured to identify undiagnosed diabetes and prediabetes (i.e., impaired fasting glucose or impaired glucose tolerance) in them. Previously diagnosed diabetes among the female breast cancer patients was determined on the self-report and the medical record.

Results

The overall incidences of total normal glucose tolerance, prediabetes, diabetes in female breast cancer patients at initial diagnosis and during chemotherapy were 24.1% and 38.5% (p<0.05), 50.6% and 28.1% (p<0.05), and 25.3% and 33.3% (p>0.05), respectively, and the differences of normal glucose tolerance and prediabetes instead of diabetes between the two groups were statistically significant. About 84% of the total diabetes and prediabetes in the female breast cancer patients at initial diagnosis and 79.7% of those during chemotherapy need to be diagnosed with OGTT.

Conclusions

Breast cancer patients have high incidences of diabetes and prediabetes. After chemotherapy even with steroids, some breast cancer patients with abnormal glucose metabolism may even become normal. Isolated hyperglycemia 2 hours after glucose loading is common, and OGTT should be made for breast cancer patients at initial diagnosis and during chemotherapy.     

妊娠期糖尿病孕妇肠道菌群变化及其与血糖的相关性——

利用16S rDNA高通量测序技术,研究妊娠期糖尿病（GDM）孕妇的肠道菌群变化及与血糖的相关性。

2020年9月—2021年3月,选取在温州市人民医院定期产前检查并分娩的孕妇44例,根据妊娠24~28周口服75 g葡萄糖耐量试验结果分为妊娠期糖尿病组（22例）及正常对照组（22例）,收集孕妇的一般资料。通过Illumina Miseq平台对受试者粪便细菌DNA进行16S rDNA测序,比较两组肠道菌群的结构、丰度及多样性。

肠道菌群ɑ−多样性分析结果显示,GDM组孕妇Chao1、Shannon、Ace、Coverage指数与正常对照组相比,差异无统计学意义（P＞0.05）。两组孕妇肠道菌群的共同优势菌群为厚壁菌门和拟杆菌门,GDM组弯曲杆菌门比例高于对照组（P＜0.05）。LEfSe分析结果显示两组丰度有显著差异的物种共有28种,其中24种在GDM组中富集,4种在正常对照组中富集。通过Bray-Curtis dbRDA分析发现,肠道菌群结构与75 g OGTT 0 h血糖及75 g OGTT 1 h血糖呈负相关（P＜0.05）。采用Spearman相关性分析评估两组肠道菌群与OGTT血糖值的相关性,发现瘤胃球菌属、链球菌属、丁酸球菌属与OGTT 0 h血糖呈负相关（P＜0.05）;小杆菌属、布劳特菌属、Monoglobus与OGTT 1 h血糖呈负相关（P＜0.05）;毛螺旋菌属、普雷沃菌属与OGTT 2 h血糖呈负相关（P＜0.05）。

16S rDNA高通量测序有助于分析GDM孕妇肠道菌群的丰度及多样性,为研究GDM孕妇肠道菌群结构的特点及与血糖的相关性提供新的思路和理论依据。

     

Lack of Correlation Between 1,5-Anhydroglucitol Assay and Oral Glucose Tolerance Test in Patients with Cystic Fibrosis

ObjectiveTo determine whether the 1,5-anhydroglucitol (1,5-AG) assay, which reflects serum glucose levels during the preceding 2 weeks, could be used as an alternative to the current standard screening test for cystic fibrosis-related diabetes (CFRD)—the oral glucose tolerance test (OGTT).MethodsSerum 1,5-AG, hemoglobin A1c (A1C), fructosamine, and glucose at various time intervals during the OGTT were measured in 10 patients, 19 to 36 years old, with cystic fibrosis. Correlation coefficients were calculated to compare 1,5-AG with A1C, fructosamine, and serum glucose levels during the OGTT, and the mean 1,5- AG, A1C, and fructosamine for normal glucose tolerance, impaired glucose tolerance (IGT), and CFRD were compared statistically.ResultsOn the basis of the 120-minute OGTT, 1 of the 10 study subjects had CFRD and 4 had IGT. The mean 1,5-AG for patients with normal glucose tolerance was not significantly different from that for patients with IGT (P = .063). The 1,5-AG value was not significantly correlated with serum glucose during the OGTT, A1C, or fructosamine.ConclusionIn this pilot study, we found no significant correlation between 1,5-AG and glucose values during the OGTT or between 1,5-AG and other glycemic markers.Hence, the utility of the 1,5-AG assay for screening for CFRD in the population of patients with cystic fibrosis may be limited. (Endocr Pract. 2010;16:167-170)     

二甲双胍对多囊卵巢综合征肥胖型患者LH和FSH的影响

目的：探讨二甲双胍对多囊卵巢综合征肥胖型患者血清中胰岛素、LH和FSH水平的影响。方法：将84例PCOS肥胖型患者随机分成44例对照组（克罗米芬）和40例观察组（二甲双胍）,采用放射免疫法测定黄体生成素（LH）和卵泡刺激素（FSH）的水平,分别于服药前（0分钟）和服后60、120分钟经前臂静脉采血,测血糖浓度及血清胰岛素水平。结果：对照组患者治疗前0min、60min及120min的血糖OGTT分别为（4．57±0．25）mmol／L、（8．38±7．05）mmol/L（7.21±0．12）mmol／L。治疗后0min、60min及120min的血糖OGTT无明显变化。观察组患者治疗前0min、60min及120min的血糖OGTT分别为（4．11±0．31）mmol／L、（8．23±6．57）mmol／L及（7．25±0．13）mmol／L,治疗后0min、60min及120min的血糖0GTT明显降低。对照组患者治疗前血清中胰岛素为（47．32±9．52）U／ml,治疗后为（42．25±7．65）U／ml,治疗前后无明显差异。观察组患者治疗前血清中胰岛素为（46．41±6．11）U／ml,治疗后血清胰岛素水平明显降低。对照组患者治疗后血清中LH为（17．22±2．14）mU／ml,FSH为（1．24±0．33）mU／ml,而与对照组相比,观察组患者血清中的LH明显降低,而FSH水平升高。结论：二甲双胍导致多囊卵巢综合征患者血清中胰岛素水平降低,从而减轻了胰岛素对LH的刺激作用,使LH水平下降,FSH升高,进而改善机体的激素紊乱,最终达到治疗PCOS的目的。     

链脲佐菌素诱导SD和Wistar大鼠糖尿病模型的影响因素

目的通过注射链脲佐菌素（STZ）制作SD和Wistar大鼠糖尿病模型,观察大鼠品系、给药剂量、给药次数对大鼠成模率、死亡率的影响,同时研究利用口服葡萄糖耐量试验（OGTT）判断大鼠糖尿病成模率的意义。方法设置共同的正常对照组,①Wistar大鼠随机分为中剂量组（55 mg/kg）和高剂量组（65 mg/kg）;②SD大鼠一次性腹腔注射STZ（55 mg/kg）,与①中的Wistar大鼠作对比;③SD大鼠随机分为一次给药组和两次给药组,注射剂量均为55 mg/kg,观察期间进行OGTT。结果①Wistar大鼠成模率和死亡率均高于SD大鼠;②采用SD大鼠、中剂量给药和两次给药的方式可提高成模率,并降低死亡率;③在有明确胰岛病理改变的模型组大鼠,其OGTT异常阳性率显著高于空腹血糖异常阳性率。结论用STZ诱导糖尿病模型是一种稳定可靠的方法。Wistar大鼠成模率和死亡率均高于SD大鼠;选用中剂量给药及两次给药的方式可提高SD大鼠成模率,并降低死亡率,维持时间较长。在动物实验中OGTT比空腹血糖监测更有诊断意义,不易造成漏诊。     

Reduction of C-peptide secretion in noninsulin-dependent diabetic patients with long duration of insulin treatment

We examined the responses of serum free C-peptide immunoreactivity (CPR) during a 100 g oral glucose tolerance test (OGTT) on diabetic patients undergoing different kinds and durations of treatment. None of the patients were ketosis-prone or had any history of nephropathy and they all developed diabetes when over the age of 30. The sigma serum free CPR (the sum of serum free CPR values during OGTT) of group A (duration of insulin treatment was less than 5 years, N = 10) was found to be higher than that of group B (duration of insulin treatment was 5 years or more, N = 10) (p less than 0.005). On the other hand, the sigma serum free CPR of group C (treatment with an oral hypoglycemic agent for less than 5 years, N = 9) was not statistically different from that of group D (treatment with an oral hypoglycemic agent for 5 years or more, N = 11). There were no statistical differences between group A and group B in age at onset, duration of diabetes, daily insulin dose, relative body weight index, serum creatinine or sigma BG (the sum of blood glucose values during OGTT). Just before the start of insulin treatment, there were no significant differences between the two groups in the following: 1. fasting blood glucose values (all 10 patients measured in group A and 9 patients in group B) 2. blood glucose and plasma immunoreactive insulin (IRI) responses (7 patients measured in group A and 6 in group B). Among those with plasma IRI measured on the previous occasion, sigma serum free CPR was found to be higher in group A than in group B (p less than 0.025) at the time of the present study.(ABSTRACT TRUNCATED AT 250 WORDS)     

Homocysteine levels in acromegaly patients

Acromegaly is associated with a two to three-fold increase in mortality related predominantly to cardiovascular disease. The excess mortality is associated most closely with higher levels of growth hormone (GH). Survival in acromegaly may be normalized to a control age-matched rate by controlling GH levels; in particular, GH levels less than 2.5 ng/mL are associated with survival rates equal to those of the general population. Hyperhomocysteinemia has also been recognized as a risk factor for cardiovascular disease, yet there are limited data on the prevalence of hyperhomocysteinemia in patients with acromegaly. Eighteen acromegaly patients (7 male, 11 female, mean age 42.8 +/- 11.0 years) in our endocrine clinic consented to having the following tests performed: complete blood count (CBC), thyroid hormones, folic acid, vitamin B12, plasma homocysteine levels, uric acid, fibrinogen, CRP, fasting glucose, insulin, C-peptide, total serum cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, GH, insulin-like growth factor-1 (IGF-1) and GH levels after an oral glucose tolerance test (OGTT). By history, fourteen had macroadenomas and four had microadenomas; eight had hypertension; two had glucose intolerance, and four had diabetes. Fifteen had had transsphenoidal or transfrontal surgery: two had been cured, but 13 others were taking long-acting octreotide. Five patients had undergone radiotherapy and the acromegaly in two was treated primarily with long-acting octreotide. CBC, thyroid hormone, folic acid, and vit B12 levels were normal in all patients. We divided the patients into two groups according to mean GH levels after an OGTT: Group 1 (GH<2.5 ng/mL, n=10), and Group 2 (GH<2.5 ng/mL, n=8). Comparison of the two groups using Mann-Whitney U testing revealed statistically significant lower levels in Group 1 of the following parameters: GH (1.91 +/- 0.90 vs. 8.58 +/- 5.55 ng/mL, p=0.002), IGF-1 (338.30 +/- 217.90 vs. 509.60 +/- 293.58 ng/dL, p=0.06), GH after an OGTT (1.42 +/- 0.81 vs. 9.01 +/- 4.53 ng/mL, p=0.001), plasma homocysteine (12.85 +/- 4.47 vs. 18.20 +/- 4.99 micromol/L, p=0.05), total cholesterol (164.0 +/- 20.81 vs. 188.0 +/- 22.26 mg/dL, p=0.05) and LDL cholesterol (81.0 +/- 9.64 vs. 116.70 +/- 13.03 mg/dl, p=0.01). Differences between the other parameters were not significantly different. Acromegaly patients with high GH levels after an OGTT have much higher levels of homocysteine than patients with lower GH levels. The role of elevated homocysteine levels as an independent cardiovascular risk factor in the mortality of acromegaly patients should be determined in future studies.     

Enhanced Intestinal Motility during Oral Glucose Tolerance Test after Laparoscopic Sleeve Gastrectomy: Preliminary Results Using Cine Magnetic Resonance Imaging

Background

Enhanced secretion of glucagon-like peptide-1 (GLP-1) has been suggested as a possible mechanism underlying the improvement in type 2 diabetes mellitus (T2DM) after laparoscopic sleeve gastrectomy (LSG). However, the reason for enhanced GLP-1 secretion during glucose challenge after LSG remains unclear because LSG does not include intestinal bypass. In this study, we focused on the effects of LSG on GLP-1 secretion and intestinal motility during the oral glucose tolerance test (OGTT) using cine magnetic resonance imaging (MRI) before and 3 months after LSG.

Methods

LSG was performed in 12 obese patients with a body mass index >35 kg/m². Six patients had T2DM. OGTT was performed before and 3 months after the surgery. Body weight, hemoglobin A1c (HbA1c), and GLP-1 levels during OGTT were examined, and intestinal motility during OGTT was assessed using cine MRI.

Results

Body weight was significantly decreased after surgery in all the cases. HbA1c was markedly decreased in all the diabetic subjects. In all cases, GLP-1 secretion during OGTT was enhanced and cine MRI showed markedly increased intestinal motility at 15 and 30 min during OGTT after LSG.

Conclusions

LSG leads to accelerated intestinal motility and reduced intestinal transit time, which may be involved in the mechanism underlying enhanced GLP-1 secretion during OGTT after LSG.     

A Comparison of the Oral and Intravenous Glucose Tolerance Tests in Non-Diabetic,Possible Diabetic and Diabetic Subjects

Results of standard three-hour oral glucose tolerance tests (OGTT) and intravenous glucose tolerance tests (IVGTT), performed on the same subjects, were compared in an attempt to determine their value in the diagnosis of borderline diabetes. A total of 83 such tests were carried out on 81 subjects. Applying the U.S. Public Health Service point count method to the results of the OGTT test, there were 38 normals, 23 possible diabetics and 22 diabetics. A constant (K) was calculated from the glucose disappearance rate in the IVGTT curves.K disagreed with the OGTT classification to a significant extent, especially in the possible diabetic and non-diabetic groups. Also, the correlation coefficients between K and the OGTT values were not impressive. This does not mean that one test is superior to the other, only that the accuracy of either test in diagnosing early diabetes is doubtful.Technically, the IVGTT was more difficult and time-consuming, and six of the 81 subjects suffered from thrombophlebitis at the site of glucose injection.     

二甲双胍对多囊卵巢综合征肥胖型患者LH 和FSH 的影响

目的:探讨二甲双胍对多囊卵巢综合征肥胖型患者血清中胰岛素、LH和FSH水平的影响。方法:将84例PCOS肥胖型患者随机分成44例对照组(克罗米芬)和40例观察组(二甲双胍),采用放射免疫法测定黄体生成素(LH)和卵泡刺激素(FSH)的水平,分别于服药前(0分钟)和服后60、120分钟经前臂静脉采血,测血糖浓度及血清胰岛素水平。结果:对照组患者治疗前0min、60min及120min的血糖OGTT分别为(4.57±0.25)mmol/L、(8.38±7.05)mmol/L及(7.21±0.12)mmol/L,治疗后0min、60min及120min的血糖OGTT无明显变化。观察组患者治疗前0min、60min及120min的血糖OGTT分别为(4.11±0.31)mmol/L、(8.23±6.57)mmol/L及(7.25±0.13)mmol/L,治疗后0min、60min及120min的血糖OGTT明显降低。对照组患者治疗前血清中胰岛素为(47.32±9.52)U/m l,治疗后为(42.25±7.65)U/ml,治疗前后无明显差异。观察组患者治疗前血清中胰岛素为(46.41±6.11)U/ml,治疗后血清胰岛素水平明显降低。对照组患者治疗后血清中LH为(17.22±2.14)mU/ml,FSH为(1.24±0.33)mU/m l,而与对照组相比,观察组患者血清中的LH明显降低,而FSH水平升高。结论:二甲双胍导致多囊卵巢综合征患者血清中胰岛素水平降低,从而减轻了胰岛素对LH的刺激作用,使LH水平下降,FSH升高,进而改善机体的激素紊乱,最终达到治疗PCOS的目的。     

Insulin secretion, glycosylated haemoglobin and islet cell antibodies in cystic fibrosis children and adolescents with different degrees of glucose tolerance.

In comparison with 12 weight-matched controls, 39 children and adolescents with cystic fibrosis (CF) showed higher fasting glycaemic levels and both delayed and enhanced blood glucose responses to OGTT. Glycaemic response was normal in 30/39 patients (76.9%), impaired in other 7 cases (18%) and diabetic in the remnant two (5.1%). Fasting insulin levels and total insulin output during OGTT did not differ in patients and controls, but insulin peak in CF group was delayed and sustained. In the whole CF series mean HbA1c was higher than in controls but no difference was found between patients with normal and those with impaired glucose tolerance. Islet cell antibodies were absent in the entire CF group. In conclusion, our results confirm the raised prevalence in CF of glucose tolerance abnormalities, which do not seem to depend on auto-immune factor involvement. Delayed insulin response to OGTT can be considered a very early expression of beta cell impairment in the course of CF. In our experience HbA1c assay did not constitute a sensitive and specific screening test for detection of the C patients with glucose intolerance.     

Glycolipid pattern and glycosilated hemoglobin (HbA 1) in a group of arteriosclerotic subjects

Total glycosilated haemoglobin (HbA1) concentration, serum triglyceride and cholesterol levels were measured in 55 arterio sclerotic patients classified in three groups: (A) normal, (B) borderline and (C) chemical diabetics according to their OGTT results. HbA1 values were high only in group C. In these patients the HbA1 concentrations correlated to the serum glucose peaks and serum triglyceride levels. Therefore we believe that the HbA1 concentration can be considered an index of the degree of carbohydrate imbalance in arteriosclerotic patients who frequently have high triglyceride levels and carbohydrate intolerance.