Cem Onur Kirac

Effects of Glucose Ingestion on Serum Fractalkine Levels in Healthy Subjects and Newly Diagnosed Type 2 Diabetic Patients

Summary Fractalkine (FKN) is an inflammatory cytokine that has been shown with increased serum levels in diabetic patients and is considered to contribute to the adipose tissue inflammation by supporting monocyte adhesion to adipocytes which has an important role in the pathogenesis of type 2 diabetes mellitus (T2DM). Our aim was to evaluate the effects of glucose ingestion on the serum fractal - kine levels in healthy subjects with normal glucose tolerance (NGT) and newly diagnosed T2DM patients. A total of 67 patients were included in this study, and they were divided into NGT (n=34) and T2DM (n=33) groups according to their oral glucose tolerance test (OGTT) results. The serum FKN and C-reactive protein (CRP) levels were measured at 0 and 120 minutes during an OGTT following overnight fasting. The 0-minute (basal) and 120-minute OGTT FKN levels were found to be significantly higher in the T2DM group when compared to the NGT group (p=0.012 and p=0.001, respectively). However, no significant differences were observed in terms of the changes in the basal and 120-minute OGTT FKN levels in the T2DM and NGT groups (p=0.433 and p=0.06, respectively). A significant positive correlation was observed between the 120-minute OGTT FKN and glucose levels in the study group consisting of all of the patients (r=0.331, p=0.006). Conclusions: In this study, basal and post-glycemic load FKN levels were found to be higher in newly diagnosed T2DM patients than those with NGT; however, there was no additional change in FKN levels by glycemic load.

Efficacy comparison of oral rosuvastatin versus oral progesterone and bevacizumab on regression of surgically endometriotic implants in rats

Abstract This study hypothesizes that oral rosuvastatin, oral dienogest and intraperitoneal bevacizumab might improve endometriosis in randomly selected female Wistar albino rats with surgically endometriotic implants. Thirty female Wistar albino rats with surgically endometriotic implants were randomized into three treatment groups: oral rosuvastatin (20 mg kg/day; oral rosuvastatin group 1; n = 10), oral progesterone (dienogest group 2; n = 10) and intraperitoneal bevacizumab (2.5 mg/kg of single intraperitoneal injection of bevacizumab; bevacizumab group 3; n = 10), for 10 days. Post-treatment variables were compared. The oral rosuvastatin group showed higher reduction for the glandular epithelium and uterine vessels of histopathological scores values than the oral progesterone group (both, p < 0.017, respectively). The median glandular epithelium and uterine vessels and histopathological scores values did not show a statistically significant difference between group 1 and group 3 (p > 0.017). Endometrial thickness values and uterine volume values were more significantly reduced in the oral rosuvastatin group than the oral progesterone group (both, p < 0.017, respectively). Moreover, endometrial thickness and uterine volume values were not different in groups wecompared with group 3 (p > 0.017). In conclusion, oral rosuvastatin and intraperitoneal injection of bevacizumab may cause more significant regression of surgically endometriotic implants in rats than oral progesterone medications.

A new experience for incorrect insulin administration

We read with great interest the recent publication ‘Errors in insulin treatment management and risk of lipohypertrophy’ by Pozzuoli et al. [1]. The authors remarked that although the patients in their centre were given information on insulin usage, the data showed that 46.3% of participants did not rotate the site of injection and 34.1% always injected within a quadrant in the same site. We want to add to this our experience of another form of incorrect usage of insulin pens. A 56-year-old male patient was followed up over a 2-year period in our outpatient clinic for type 2 diabetes mellitus (T2DM). During the 2 years, this patient was hospitalized six times because of high HbA1c levels and discharged with regulated blood glucose levels using a combination of 0.6 IU/kg insulin doses and vildagliptin–metformin. When the patient came for checks, his insulin doses were observed to have increased about 1.2 IU/kg, according to his selfmonitoring of blood glucose. In his anamnesis, the patient indicated compliance with the dietician’s suggestions, and his weight was found to be stable. When the patient was questioned about his insulin use technique, it was learnt that he ejected insulin to empty air bubbles from the insulin pen before each injection, even if there were no such bubbles. Thus, the 6–8 IU of insulin in each injection was made incomplete. The patient was given another patient training and his blood glucose levels were regulated. The prevalence of diabetes is increasing worldwide, and, because of their decreased insulin reserve, most patients with T2DM ultimately need insulin treatment. About 35% of diabetes patients in India are on insulin treatment [2]. Since the number of treated patients is so high, the increase both in complications and cost of the treatment due to mistakes made in the administration of insulin becomes an important issue. For example, lipohypertrophy (LH) is the most common complication following incorrect insulin usage, and the mean daily insulin doses are significantly higher in patients with LH versus those without. In Spain, this difference equates to a total annual cost to the national healthcare system of over €122 million [3]. Here, it is noted that air can enter the insulin pen during manufacture or if the needle is left on the pen, thus creating air bubbles—in which case the needle should be primed with insulin prior to injection; however, if there are no air bubbles, this is an unnecessary and incorrect administration technique. The most important factor in optimizing the use of insulin by the patient is a devoted and practical insulin education. Through repeated insulin usage trainings, we can prevent patients from incorrectly administering insulin as well as remind them of the importance of nutrition and physical activity. Indeed, it has been reported that patients receiving intensive insulin therapy with high levels of HbA1c showed a significant metabolic control (regardless of their out-/ inpatient status) when this was combined with a ‘refresher’ patient education programme [4]. If there appears to be an issue with patient treatment, the insulin training should be repeated and the patient observed how to see how they administer the insulin.