Alexandre Wajngot

Minimal Increases in Glucagon Levels Enhance Glucose Production in Man with Partial Hypoinsulinemia

In man a small dose of somatostatin (50 (μg/h) suppressed moderately basal insulin (5 μU/ml) and glucagon (40 pg/ml) levels. This resulted in a short-lasting hypoglycemia, which was then followed by marginal hyperglycemia throughout the experiment. The addition of a minimal dose of glucagon (0.50 ng/kg/min) to somatostatin normalized basal glucagon levels and resulted in a significant and sustained hyperglycemia. During the first 2 h, hyperglycemia was mainly due to increased glucose production, whereas later on it was maintained by decreased glucose uptake. We conclude that, in man moderately deprived of insulin, even a marginal change in glucagon level induces a long-lasting hyperglycemia.

Glucose tolerance, insulin release, and insulin sensitivity in normal-weight women with previous gestational diabetes mellitus

Out of 57 women with previous histories of gestational diabetes (GD), 23 were of normal weight postpartum and willing to participate in three studies characterizing oral glucose tolerance (OGTT), insulin responsiveness to intravenous glucose (glucose infusion test, GIT), and insulin sensitivity (somatostatin, insulin, and glucose infusion test, SIGIT). The experiments were performed 6-36 mo after cessation of breast-feeding. The control group comprised 10 healthy women with normal OGTT matched for age and weight. Among subjects with previous histories of GD, 9 had normal, 8 borderline, and 6 decreased OGTT. As a group, women with previous histories of GD have significantly decreased insulin response and insulin sensitivity. Furthermore, all 14 with borderline and decreased OGTT demonstrated a low early insulin response during GIT (5-min value below the upper border of the lower quartile of normals), whereas insulin sensitivity was normal in 6 and low in 8 (glucose values attained during SIGIT were lower di higher, respectively, than the lower border of the upper quartile of controls). The women with previous histories of GD and normal OGTT exhibited normal (n = 4) and low (n = 5) insulin responses. Three of the former subjects had low and the remaining 6 had normal insulin sensitivity. In conclusion, as many as 60% of normal-weight women with previous histories of GD had borderline or decreased OGTT 6- 36 mo postpartum. This derangement could be due to impaired early insulin response, which in some subjects was combined with low insulin sensitivity. Follow- up of women with previous histories of GD might enlighten the pathogenesis of non-insulin-dependent diabetes mellitus.

On the Pathogenesis of Maturity-Onset Diabetes

Diabetes mellitus most probably is a syndrome resulting from different genetic as well as environmental causes. By far the most common type of diabetes is the one which, at least in the beginning, is non-insulin requiring and non-ketosis prone, sometimes called maturity-onset or type 2 diabetes. Most often it is diagnosed in adults and elderly subjects. It has been amply demonstrated that genetic factors play a decisive role in the development of this type of diabetes. It is generally accepted that the disease develops stepwise from a genetically determined initial stage (prediabetes), to chemical diabetes with decreased glucose tolerance only, and finally to manifest diabetes. This course can be slow or more rapid depending on the weight of those factors that usually precipitate this type of diabetes: overweight, age, stress, drugs, etc.

Low Insulin Response: A Marker Of Prediabetes

It is generally accepted that genetic factors play a decisive role in the development of non-insulin dependent diabetes (NIDDM). Accordingly, the manifest disease develops gradually from a genetically determined initial stage, prediabetes, over a stage characterized by a decrease in glucose tolerance only. This process might be slow or rapid, possibly dependent on the type and ‘weight’ of the genetic trait as well as on factors precipitating the disease.

Psychosocial problems in patients with newly diagnosed diabetes: Number and characteristics

Early in the course of diabetes, it is important to identify and support patients whose psychosocial situations and reactions to the diagnosis may affect their ability to adjust or take adequate responsibility for self-care. We aimed to identify (a) the number and characteristics of patients, 18-65 years, newly diagnosed with diabetes, who needed psychosocial interventions and (b) the type of psychosocial problems they had. A total of 106 patients (72 men) were included in the study. Interviews showed that 41.5% had psychosocial problems. Fifteen dropped out early in the study; 38% of those remaining had psychosocial problems (PSP). More than half had problems with their life situation; most commonly in relationships. About a third had problems related to diabetes, most commonly, work-related. Compared to other participants, PSP patients lived in more strained social situations, especially regarding personal finances and social support. More of the PSP patients were anxious and depressed. They used negative coping strategies more often and more frequently expected that diabetes would negatively affect their future. In conclusion, early in the course of diabetes, screening instruments should be used to identify PSP patients. Treatment by medical social workers skilled in diabetes care should be offered.

Poor self-rated health in adult patients with type 2 diabetes in the town of Södertälje: A cross-sectional study.

Abstract Objective. Several studies indicate that ethnicity may be a strong predictor of poor self-rated health (SRH). The aims of the present study were to investigate whether there was an association between ethnicity and poor SRH in subjects with type 2 diabetes and to determine if the association remained after adjusting for possible confounders such as age, gender employment, marital status, and education. Design. A cross-sectional study based on a patient population in the town of Södertälje. An unconditional logistic regression was performed to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs). Setting. Four primary health care centers. Subjects. A total of 354 individuals were included: Assyrian/Syrian-born (n = 173) and Swedish-born (n = 181). Results. The odds ratio for rating poor SRH for Assyrian/Syrian subjects with type 2 diabetes was 4.5 times higher (95% CI = 2.7–7.5) than for Swedish patients in a crude model. After adjusting for possible confounders, unemployed/retired people had 5.4 times higher odds for reporting poor SRH than employees (OR = 5.4; 95% CI = 2.3–12.5). Women had 1.8 times higher odds (95% CI = 1.0–3.0) for reporting poor SRH than men. In the final model poor SRH among Assyrians/Syrians decreased but still remained significant (OR=3.7; 95% CI = 2.5–6.6). Conclusions. The findings in this study are important for planning primary health care services. They highlight the crucial importance of being aware of the subjective health status of immigrants fleeing from war in the Middle East and resettling in Sweden.

Ethnic differences in dissatisfaction with sexual life in patients with type 2 diabetes in a Swedish town.

BackgroundThe first aim of this study was to analyze whether self-reported satisfaction with ones sexual life was associated with ethnicity (Swedish and Assyrian/Syrian) in patients with type 2 diabetes. The second was to study whether the association between satisfaction with ones sexual life and ethnicity remained after controlling for possible confounders such as marital status, HbA1c, medication, and presence of other diseases.MethodsThis cross-sectional, questionnaire-based study was conducted at four primary health care centers in the Swedish town of Södertälje. A total of 354 persons (173 ethnic Assyrians/Syrians and 181 ethnic Swedes) participated.ResultsThe total prevalence of self-reported dissatisfaction with ones sexual life in both groups was 49%. No significant ethnic differences were found in the outcome. In the final model, regardless of ethnicity, the odds ratio (OR) for self-reported dissatisfaction with ones sexual life in those ≥ 70 years old was 2.52 (95% CI 1.33-4.80). Among those living alone or with children, the OR was more than three times higher than for married or cohabiting individuals (OR = 3.10, 95% CI 1.60-6.00). Those with other diseases had an OR 1.89 times (95% CI 1.10-3.40) higher than those without other diseases.ConclusionsThe findings demonstrate that almost half of participants were dissatisfied with their sexual life and highlight the importance of sexual life to people with type 2 diabetes. This factor should not be ignored in clinical evaluations. Moreover, the findings demonstrate that it is possible to include questions on sexual life in investigations of patients with type 2 diabetes and even in other health-related, questionnaire studies, despite the sensitivity of the issue of sexuality.

Cardiovascular risk factors in Assyrians/Syrians and native Swedes with type 2 diabetes: a population-based epidemiological study

BackgroundA large number of people throughout the world have diabetes and the prevalence is increasing. Persons with diabetes have a twice higher risk of cardiovascular disease than those without diabetes. There is a lack of studies focusing on cardiovascular risk factors in Assyrians/Syrians with type 2 diabetes. The aim of this study is to estimate the prevalence of some cardiovascular risk factors among Assyrians/Syrians and native Swedes with type 2 diabetes and to study whether the association between ethnicity and cardio-vascular risk factors remains after adjustment for age, gender, employment status and housing tenure.MethodsIn the Swedish town of Södertälje 173 Assyrians/Syrians and 181 ethnic Swedes with type 2 diabetes participated in a study evaluating cardiovascular risk factors such as increased haemoglobin A1c (HbA1c), high blood lipids (total serum cholesterol and triglycerides), hypertension and high urinary albumin. The associations between the outcome variables and sociodemographic characteristics were estimated using unconditional logistic regression.ResultsThe prevalence of increased triglycerides in Swedish-born subjects and Assyrian-Syrians was 61.5% and 39.7% respectively. Swedes had a prevalence of hypertension 76.8% compared to 57.8% in Assyrians/Syrians. In the final logistic models adjusted for gender, age, housing and employment the odds ratio (OR) for Swedish-born subjects for increased triglycerides was 2.80 (95% CI1.61-4.87) and for hypertension 2.32 (95% CI 1.35-4.00) compared to Assyrians-Syrians.ConclusionEthnic Swedes had higher prevalence of increased triglycerides and hypertension than Assyrians/Syrians. Total cholesterol, HbA1c and urinary albumin did not differ between the two ethnic groups.

Glucose Potentiation of Arginine-Induced Insulin Secretion is Impaired in Subjects With a Glucokinase Glu256Lys Mutation

Insulin and glucagon release and insulin sensitivity were investigated in patients with glucokinase deficiency. Five subjects with a missense mutation (Glu256Lys) were studied. They were compared with six healthy subjects with low insulin response but normal glucose tolerance. Insulin and glucagon levels were measured at blood glucose 7.1 ± 0.1 mmol/l and at 10.9 ± 0.2 mmol/l with or without arginine (5 g i.v.). Insulin sensitivity was assessed as the ratio between infused glucose and the insulin level (M:I) during hyperglycemic clamps. Glu256Lys subjects were nonobese and had fasting blood glucose 6.7 ± 0.1 mmol/l (P < 0.001 vs. control group). Insulin release was reduced in response to 11 mmol/l glucose (61% of control group, P < 0.05) as well as to arginine in the presence of 11 mmol/l glucose (54% of control group, P < 0.01). Also, the slope of potentiation, i.e., the enhancement of arginine-induced release as a function of prevailing glucose concentration, was reduced (delta insulin/delta glucose, 47% of control group, P < 0.05). As for glucagon release, the response to arginine was not inhibited normally by glucose, resulting in threefold higher levels at 11 mmol/l glucose versus control subjects. Insulin sensitivity, assessed as M:I, was significantly (P < 0.05) reduced (55% of control group). Glucokinase deficiency thus affects not only insulin responses to glucose per se but also glucose potentiation of responses to non-nutrient secretagogues. Abnormalities in glucagon release and insulin sensitivity coexist with attenuated insulin responses in glucokinase-deficient subjects.

Coping strategies among patients newly diagnosed with diabetes or rheumatoid arthritis at baseline and after 24 months

Patients aged 18–65 years with newly diagnosed diabetes mellitus (n = 89) or rheumatoid arthritis (n = 100) were studied by the General Coping Questionnaire at baseline and after 24 months. In total, 34 diabetes mellitus and 46 rheumatoid arthritis patients were diagnosed with psychosocial problems. The use of negative coping strategies, such as protest, isolation, and intrusion, was associated mostly with being classified as having psychosocial problems. With the risk of experiencing a strong impact of the disease at 2 years of follow-up as outcome, intrusion was a significant and independent risk factor, while minimization was a significant and independent protective factor.