Harn-Shen Chen

Beneficial Effects of Insulin on Glycemic Control and β-Cell Function in Newly Diagnosed Type 2 Diabetes With Severe Hyperglycemia After Short-Term Intensive Insulin Therapy

OBJECTIVE—To evaluate whether treatment with insulin is advantageous compared with oral antidiabetes agents in newly diagnosed type 2 diabetes with severe hyperglycemia after short-term intensive insulin therapy. RESEARCH DESIGN AND METHODS—Newly diagnosed type 2 diabetic patients with severe hyperglycemia were hospitalized and treated with intensive insulin injections for 10–14 days. The oral glucose tolerance test (OGTT) was performed after intensive insulin treatment. After discharge, the patients were randomized to receive either insulin injections or oral antidiabetes drugs (OADs) for further management. The OGTT was repeated 6 months later, and β-cell function and insulin sensitivity were evaluated again. These subjects were continually followed up for another 6 months to evaluate their long-term glycemic control. RESULTS—At the 6th month of the study, the A1C level was significantly lower in the insulin group than in the OAD group (6.33 ± 0.70% vs. 7.50 ± 1.50%; P = 0.002). During the follow-up visit, the A1C level was still better in the insulin group (6.78 ± 1.21% vs. 7.84 ± 1.74%; P = 0.009). All parameters regarding β-cell function measured in the OGTT were improved significantly in both groups after 6 months of treatment. Compared with the OAD group, the homeostasis model assessment of β-cell function index, insulin area under the curve, and insulinogenic index were better in the insulin group. CONCLUSIONS—A 6-month course of insulin therapy, compared with OAD treatment, could more effectively achieve adequate glycemic control and significant improvement of β-cell function in new-onset type 2 diabetic patients with severe hyperglycemia.

Hemoglobin A1c and Fructosamine for Assessing Glycemic Control in Diabetic Patients With CKD Stages 3 and 4

BACKGROUND Hemoglobin A(1c) (HbA(1c)) and fructosamine can be used to monitor glycemic control in diabetic patients with normal kidney function, but their validity in patients with chronic kidney disease (CKD) has not been evaluated. In this study, we evaluated the correlation and accuracy of these 2 measures of glycemic control in type 2 diabetic patients with CKD stages 3-4. STUDY DESIGN Diagnostic test study. SETTING & PARTICIPANTS Type 2 diabetic patients with normal (n = 30) and abnormal kidney function (n = 30) were recruited in Taipei Veterans General Hospital, Taiwan. INDEX TESTS HbA(1c) and fructosamine. REFERENCE TEST Self-monitoring of blood glucose levels. MEASUREMENTS Blood glucose measurements consisted of 6 preprandial, 6 postprandial, and 2 bedtime assessments in a week with a cycle of 4-week intervals for 12 weeks. RESULTS Correlation coefficients between HbA(1c) level or fructosamine-albumin ratio and mean blood glucose levels were 0.836 and 0.645 in participants with normal kidney function and 0.813 and 0.649 in participants with CKD stages 3-4, respectively. In patients with CKD stages 3-4, mean blood glucose levels in weeks 1-12 were 21.9 mg/dL (95% CI, 11.6-32.5) higher than estimated average glucose (eAG) levels calculated from HbA(1c) levels in participants with normal kidney function. In patients with CKD stages 3-4, mean blood glucose levels in weeks 10-12 were 15.5 mg/dL (95% CI, 5.2-30.5) higher than eAG levels calculated from fructosamine levels in participants with normal kidney function, but without statistical significance when eAG calculated from fructosamine level was corrected for serum albumin level (difference of 5.6 mg/dL; 95% CI, -8.6 to 19.8). LIMITATIONS Relatively small number of participants with limited amount of blood glucose measurement data. CONCLUSION Our data show that eAG calculated from HbA(1c) and fructosamine levels might underestimate mean blood glucose levels in patients with CKD stages 3-4. References ranges may need to be modified when interpreting results of measurements of glycemic control in type 2 diabetic patients with CKD.

Improvement of glycaemia control in subjects with type 2 diabetes by self‐monitoring of blood glucose: comparison of two management programs adjusting bedtime insulin dosage

Aim:  Self‐monitoring of blood glucose (SMBG) is important for patients treated with insulin to detect asymptomatic hypoglycaemia and to guide patients towards reaching blood glucose goal. This study compared two management programs for adjusting bedtime insulin dose: program 1 (performed by study subjects) vs. program 2 (performed by study subjects and reminded by investigators).

Interaction between glycaemic control and serum insulin-like growth factor 1 on the risk of retinopathy in type 2 diabetes.

Eur J Clin Invest 2012; 42 (4): 447–454

Myocardial heat shock protein 60 expression in insulin-resistant and diabetic rats

Heat shock protein 60 (HSPD1) plays a critical role in myocardial protection. Its reduced expression may lower myocardial protection against ischemic injury in the diabetic state. This study was conducted to investigate the natural course of fructose-fed insulin-resistant rats, define changes in myocardial HSPD1 expression, and determine the effects of thiazolidinedione or anti-hypertensive treatment. Results showed that insulin resistance with hyperinsulinemia and hypertension developed after 6 weeks of fructose feeding. This time-course study also showed that myocardial HSPD1 expression was mildly increased in week 6 (P=0.05) and significantly increased in week 8. Rosiglitazone-treated rats had restored systolic blood pressure (BP) and normalized plasma insulin level during oral glucose tolerance tests, whereas amlodipine-treated rats restored only systolic BP. Both amlodipine and rosiglitazone treatments normalized the abundance of myocardial HSPD1 expression in fructose-fed rats. When these rats received streptozotocin injection and diabetes developed, myocardial HSPD1 expression decreased despite persistent hypertension. In conclusion, this is the first study to report that myocardial HSPD1 expression is increased in high-fructose-fed rats, which may be due to increased BP. Once the high-fructose-fed rats developed diabetes with insulin deficiency, the myocardial HSPD1 expression decreased in spite of persistent hypertension.

The role of insulin-like growth factor-1 and growth hormone in the mortality of patients with acromegaly after trans-sphenoidal surgery.

CONTEXT Acromegaly is associated with a significant increase in mortality. With the development of new modalities of treatment, it has become important to identify prognostic factors relating to mortality. OBJECTIVE This study aimed to determine the all-cause mortality of patients with acromegaly after trans-sphenoidal surgery, and assess the impact of biochemical markers on survival. DESIGN Two hundred thirty-four patients were admitted to the Taipei Veterans General Hospital for acromegaly between 1979 and 2007. Of the 163 patients who underwent trans-sphenoidal surgery, 142 had data available for insulin-like growth factor-1 (IGF-1), and their survival status was analyzed. Serial data for fasting growth hormone (GH) and IGF-1 were collected. This study also used the last follow-up data for mortality analysis. The patients with acromegaly were grouped according to the last follow-up GH level (≤2 or >2 μg/L) and IGF-1 SD score (≤2 or >2). All-cause mortality was followed to the end of 2007 and compared to the general Taiwanese population by standardized mortality ratios. RESULTS Serial GH and IGF-1 data revealed that the GH levels in the first 3 years after surgery were important predictors of mortality in acromegaly. However, there are insufficient IGF-1 data for deceased patients to determine the significance of a raised IGF-1 immediately following treatment. Comparison of crude death rates suggests that a fasting GH level of 2 μg/L and normalization of the IGF-1 level are appropriate targets. After subgroup analysis to assess the impact of discordant GH and IGF-1 levels on survival, the data showed that the elevated GH group had a trend toward a higher mortality than the elevated IGF-1 group. CONCLUSIONS An elevated GH value in the first 3 years after surgery may be the best predictor of mortality. Thus, the follow-up of patients with acromegaly at relatively frequent intervals after trans-sphenoidal surgery should be routine.

The Ankle Brachial Index Exhibits Better Association of Cardiovascular Prognosis Than Non-High-Density Lipoprotein Cholesterol in Type 2 Diabetes

Objective: The association between ankle brachial index (ABI) and outcomes in diabetic subjects is controversial. The purpose of this study was to evaluate whether the ABI is more strongly associated with cardiovascular outcomes comparing with non–high‐density lipoprotein cholesterol (non–HDL‐c). Research Design and Methods: A total of 452 type 2 diabetic subjects followed up for a mean of 5.8 years were grouped by ABI (<0.9 versus ≥0.9) and non–HDL‐c (<100 mg/dL versus ≥100 mg/dL). Primary outcomes were composite events including all‐cause mortality, hospitalization for coronary artery disease, stroke, revascularization, amputation and diabetic foot, and the secondary end point was all‐cause mortality. Results: Intergroup differences in percentage of men, duration of diabetes, hemoglobin A1c, total cholesterol, low‐density lipoprotein cholesterol, triglycerides and estimated glomerular filtration rate were significant. A total of 64 composite events and 17 deaths were recorded. A higher number of composite events occurred in the group with abnormal ABI but optimal non–HDL‐c than in those with suboptimal non–HDL‐c but normal ABI (29% versus 11%, P < 0.05). A similar trend was observed in all‐cause mortality (11% versus 1%, P < 0.05). The ABI was the dominant risk factor for both end points after adjusting other factors (for composite events, hazard ratio = 0.02, 95% CI: 0.00‐0.10, P < 0.001 and for all‐cause mortality, hazard ratio = 0.01, 95% CI: 0.00‐0.28, P = 0.006). Conclusions: The ABI was more strongly associated with outcomes in diabetes than non–HDL‐c. The ABI should be routinely screened in diabetes even without symptom.

Iodine Nutritional Status of School Children in Nauru 2015

Little is known about iodine nutritional status in island countries in the Pacific Ocean. The primary objective of this study was to report for the first time the iodine nutritional status of people in Nauru. In addition, sources of iodine nutrition (i.e., water and salt) were investigated. A school-based cross-sectional survey of children aged 6–12 years was conducted in three primary schools of Nauru. Urinary iodine concentration (UIC) was determined by spot urine samples. Available water and salt samples in Nauru were collected for the measurement of iodine content. A food frequency questionnaire was conducted. The median UIC was 142 μg/L, and 25.2% and 7.4% of the population had median UIC below 100 μg/L and 50 μg/L, respectively. Natural iodine-containing foods such as seaweeds and agar were rare. Iodine was undetectable in Nauruan tank water, filtered tap water, and raindrops. Of the analyzed salt products, five kinds were non-iodized, and three were iodized (iodine content: 15 ppm, 65 ppm, and 68 ppm, respectively). The results indicate that the iodine status in Nauruan school children is adequate. Iodized salt may serve as an important source of iodine nutrition in Nauru.