Hilda F. Ovalle

Effect on quality of life with a new insulin injection device in elderly patients with diabetes mellitus type 2

OBJECTIVE The aim was to investigate the efficacy, safety, and satisfaction of a new insulin injection device in elderly subjects with type 2 diabetes on suboptimal glycemic control with two doses of insulin NPH alone. RESEARCH DESIGN AND METHODS This study was a prospective no-blind study performed. We selected 25 patients (13 men and 12 women) with type 2 diabetes, only treated with two doses of NPH insulin (injection pen device) for more than 6 months, who did not achieved optimal glycemic control. Additional inclusion criterion was age 55 to 75 years (mean 65.6+/-8.6). All subjects were required to be able to comply with the protocol and carry out home blood glucose monitoring. RESULTS HbA1c decreased significantly from 7.8% to 7.6% (P<.05) (2.6% decreased from baseline), and breakfast and lunch preprandial glucose controls decreased significantly. Significant decrease was detected in breakfast and dinner postprandial glucose level. Taken the patients as a whole, insulin dose change significantly (29.8+/-10.9 to 28+/-10.8 Ul/day; P<.05). The number of hypoglycemic events during the 3-month treatment was similar than before treatment with Innolet (2.3+/-3.9 to 1.4+/-2.6 events; ns). The summary results indicated significantly improvement satisfaction questionnaire before 23.9+/-9 points and after 34.5+/-6.5 insulin injection device (P<.05). CONCLUSION Innolet improved glycemic control and satisfaction in a group of elderly patients with diabetes mellitus type 2 previously treated with pen devices.

Role of Genetic Variation in the Cannabinoid Receptor Gene (CNR1) (G1359A Polymorphism) on Weight Loss and Cardiovascular Risk Factors After Liraglutide Treatment in Obese Patients With Diabetes Mellitus Type 2

Background A polymorphism (1359 G/A) of the cannabinoid receptor 1 (CNR1) gene was reported as a common polymorphism (rs1049353) with potential implications in weight loss. We decide to investigate the role of this polymorphism on metabolic changes and weight loss secondary to treatment with liraglutide. Methods A population of 86 patients with diabetes mellitus type 2 and obesity, unable to achieve glycemic control (hemoglobine glycate A1c >7%) with metformin alone or associated to sulfonylurea, who require initiation of liraglutide treatment in progressive dose to 1.8 mg/d subcutaneously, was analyzed. Results Fifty-one patients (59.3%) had the genotype G1359G, and 35 patients (40.7%) had G1359A (28 patients, 32.6%) or A1359A (7 patients, 8.1%) (A allele carriers). In patients with both genotypes, basal glucose, HbA1c, body mass index, weight, fat mass, waist circumference, and systolic blood pressures decreased. In patients with G1359G genotype, total cholesterol and low-density lipoprotein cholesterol decreased, and in patients with A allele, homeostasis model assessment for insulin resistance decreased, too. Conclusions There is an association of the A allele with an improvement of insulin resistance secondary to weight loss after liraglutide treatment in obese patients with diabetes mellitus type 2. Noncarriers of A allele showed an improvement in cholesterol levels after weight loss.

The serum profile of adipokines in naïve patients with diabetes mellitus type 2 and obesity

Background: The aim of this study was to explore the relationship of serum profile of adipokines with cardiovascular risk factors and anthropometric parameters in patients with diabetes mellitus type 2. Subjects: A population of 108 obese patients with DM2 was analyzed. A complete biochemical anthropometric and nutritional evaluation was performed. Results: In the analysis with leptin as a dependent variable, the IL‐6 and glucose levels remained in the model (F = 6.2; P<0.05), with an increase of 5.8 (CI 95%:2.7–7.6) ng/ml with each 1 pg/ml of IL‐6 and of 5.2 (CI95%:2.5–5.8) ng/ml with each 1 mg/dl of glucose. In a second model with adiponectin as a dependent variable, the BMI remained in the model (F = 3.77;P<0.05), with an decrease of −3.77 (CI 95%:0.53–7.1) ng/ml with each 1 point of BMI. In the third multivariate analysis with IL‐6 as a dependent variable, the glucose level remained in the model (F = 10.1; P<0.01), with an increase of 0.09 (CI95%:0.06–0.12) pg/ml with each 1 mg/dl of glucose. In the fourth multivariate analysis with resistin as a dependent variable, the CRP remained in the model (F = 2.51; P<0.05), with an increase of 0.28 (CI 95%:0.08–0.48) pg/ml with each 1 mg/dl of CRP. Conclusion: Serum profile of adipokines is associated with different risk factors in diabetic obese patients. J. Clin. Lab. Anal. 25:409–413, 2011.

Allelic frequency of G380A polymorphism of tumor necrosis factor alpha gene and relation with cardiovascular risk factors and adipocytokines in obese patients

BACKGROUND The aim of our study was to investigate the allelic frequency of the G308A polymorphism in the TNF alpha gene and the influence of G308A this polymorphism on cardiovascular risk factors and adipokine levels in obese patients. DESIGN A population of 834 obesity patients was analyzed. A nutritional evaluation and a blood analysis were performed. The statistical analysis was performed for the combined G308A and A308A as mutant group and type G308G as wild group. RESULTS A total of 630 patients (181 males/449 females) (75.5%) had the genotype G308/G308 (wild genotype group) with an average age of 43.5 ± 14.8 years, 188 patients (61 males/127 females) (22.5%) had the genotype G308/A308 (mutant genotype group-heterozygote) and 16 patients (5 males/11 females) (1.9%) with an average age of 44.5 ± 14.2 years had the genotype A308/A308 (mutant group-homorozygote) with an average age of 44.3 ± 11.4 years, without statistical differences in the mean age or sex distribution. Genotypes G308/A308 and A308/A308 was designed (mutant genotype group) as a dominant model. Allelic frequency of the A substitucion -308 was 13.19%. Anthropometric, adipokines, insulin resistance, lipid levels ad dietary intake were similar in both genotypes. CONCLUSION In conclusion, allelic frequency of G308A polymorphism is is in accordance with allelic frequencies observed in other populations. Carries of A308 allele have the same anthropometric and metabolic profile than wild type carriers.

rs1501299 Polymorphism in the Adiponectin Gene and Their Association with Total Adiponectin Levels, Insulin Resistance and Metabolic Syndrome in Obese Subjects

Background and Aims: The aim of this study was to determine the association of single nucleotide polymorphism rs1501299 in the ADIPOQ gene with body weight, insulin resistance, serum adipokine levels and metabolic syndrome (MetS). Methods: The study involved a population of 1,007 adult obese subjects. Parameters like body weight, fat mass, waist circumferences, blood pressure, fasting blood glucose, C-reactive protein, insulin concentration, homeostasis model assessment for insulin resistance (HOMA-IR), lipid profile and adipocytokines levels (leptin, adiponectin and resistin) were all measured. The genotype of ADIPOQ gene polymorphism (rs1501299) was evaluated. Results: Insulin levels (GG: 13.6 ± 5.1 mUI/l vs. GT: 14.1 ± 5.2 mUI/l vs. TT: 16.6 ± 5.2 mUI/l; p < 0.05) and HOMA-IR (GG: 3.3 ± 1.5 units vs. GT: 4.1 ± 1.1 units vs. TT: 4.5 ± 1.3 units; p < 0.05) were higher in T-allele carriers than they were in non-T-allele carriers. Total adiponectin levels (GG: 20.2 ± 2.4 ng/dl vs. GT: 15.8 ± 3.4 ng/dl vs. TT: 13.7 ± 1.4 ng/dl; p < 0.05) were lower in T-allele carriers than they were in non-T-allele carriers. Logistic regression analysis indicated that subjects with T allele were associated with an increased risk of MetS (OR 1.15, 95% CI 1.08-1.25, p = 0.033) and an increased risk of hyperglycemia (OR 1.99, 95% CI 1.37-2.55, p = 0.028) after adjusting by age and gender. Conclusions: These data suggest an important role of this ADIPOQ variant at position +276 on insulin resistance, total adiponectin levels and MetS.

Relationship of ‐55C/T Polymorphism of Uncoupling Protein 3 (UCP3) Gene with Metabolic Syndrome by ATP III Classification

The relation of ‐55C/T polymorphism of uncoupling protein 3 (UCP3) with metabolic syndrome (MS) has been evaluated only in one previous study with contradictory results. The aim of our study was to investigate the association of ‐55C/T polymorphism of UCP3 gene with MS.

ADIPONECTIN GENE VARIANT RS rs266729: RELATION TO LIPID PROFILE CHANGES AND CIRCULATING ADIPONECTIN AFTER BARIATRIC SURGERY

BACKGROUND ADIPOQ rs266729 have been associated with body mass index and metabolic parameters. OBJECTIVES Our aim was to assess the contribution of this genetic variant on lipid profile and serum adiponectin levels after biliopancreatic diversion surgery in morbidly obese patients in a 3-year prospective study. SETTING Tertiary Hospital. METHODS A prospective cohort study (sample) of 149 patients with morbid obesity was evaluated. Biochemical and anthropometric parameters were studied at baseline and every year for a 3-year-follow-up period. RESULTS Percentage of excess weight loss (65.9% versus 66.0%:ns), body mass index, weight, waist circumference, fat mass, blood pressure, fasting glucose, low-density lipoprotein cholesterol, total cholesterol, insulin, homeostasis model assessment of insulin resistance, and triglyceride levels improved in both genotype groups. A decrease in fasting insulin levels, homeostasis model assessment of insulin resistance, total cholesterol, low-density lipoprotein cholesterol, and triglycerides was higher in non-G-allele carriers than G-allele carriers. The increase of adiponectin levels (at 1 yr) found after 1 (delta: 16.2 ± 3.1 ng/mL versus 2.1 ± 1.0 ng/mL; P = .02), 2 (delta: 24.2 ± 3.1 ng/mL versus 3.1 ± 1.1 ng/mL; P = .02), and 3 years (delta: 33.2 ± 3.9 ng/mL versus 4.7 ± 1.8 ng/mL; P = .01) was higher in non-G-allele carriers than G carriers. At all times, adiponectin levels were higher in patients with genotype CC. CONCLUSIONS Non-G allele of ADIPOQ gene variant (rs266729) is associated with increases in adiponectin levels and better improvement of low-density lipoprotein cholesterol, triglycerides, insulin, and homeostasis model assessment of insulin resistance after biliopancreatic diversion massive weight loss than G-allele carriers.

Biochemical, Anthropometric and Lifestyle Factors Related with Weight Maintenance after Weight Loss Secondary to a Hypocaloric Mediterranean Diet

Background/Aims: The aim of our study was to evaluate the influence of lifestyle factors and molecular biomarkers on the maintenance of the weight lost after a hypocaloric Mediterranean diet. Design: After 3 months on a diet, patients (n = 335) remained with no controlled diet during 3 years and they were revaluated. Results: Using linear regression, in the group of responders, we detected that a positive weight loss at 3 months, serum levels of leptin at 3 months, and each 30 min per week of physical activity were associated with weight loss maintenance. In the model with reduced weight (RW) as dependent variable, a positive weight loss at 3 months was associated with 2.4% RW (95% CI 1.31–8.11; p = 0.015), each unit of serum leptin levels at 3 months with –0.44% RW (95% CI –0.59 to –0.020; p = 0.007), each basal unit homeostasis model assessment for insulin resistance (HOMA-IR) level with –2.32% (95% CI –13.01 to –0.17; p = 0.040), and each 30 min per week of physical activity with 1.58% RW (95% CI 1.08–2.94; p = 0.020). Conclusion: Obese subjects who are on maintenance weight loss after a dietary intervention appear to have a better initial response during the 3 months intervention, more physical activity at 3 years, and lower basal HOMA-IR and leptin after weight loss than those who regain weight.

Relación de factores clínico-bioquímicos con el estadio clínico y tipo de cirugía en una muestra de pacientes con isquemia crítica de miembros inferiores

Objective: The term of critical ischemia of legs is used in patients with chronical ischemia and pain in rest, ulcer or tisular necrosis secondary to oclussive arterial disease. The objective of our work was to identify factors related with clinical stage and type of surgery in these patients. Material and methods: An observational study was performed during two years, from January 1999 to december 2000, with 330 patients with surgery secondary to critical ischemia of legs. The next parameters were recorded during the Hospital stance; age, sex, blood pressure, glycaemia, total colesterol, LDL colesterol, HDL colesterol, triglycerides, location of disease, type of surgery, arm-ankle index, andfarmacological treatment to cardiovscular risk factors. A regression logistic analyze was realized to study the influence ofdiferents variables in the clinical stage and in the type of surgery. Results: The mean age was 74.78 ± 10.35 years, with a higher age in females (78.88 ± 10.45 years) than males (73.70 ± 10.07) (p < 0,0001), with 261 males (79.1%) and 69 females (20.9%). Logistic regression model to investigate clinical stage III/IV (adjusted by age and sex) showed that the independent variables related with stage IV were diabetes mellitus, location of arterial lesion, and low colesterol levels. A patient with diabetes mellitus type 2 has 3,322 (CI 95%: 1,881-5,866) times more risk of stage IV than a non diabetic patient. Odds ratio of total colesterol was 0,990, the risk to develop a IV stage is increased 0,990 times for each mg/dl of cholesterol. Distal lesion increased the risk of stage IV en 6,897 times (CI 95%; 3,509 - 13,557). Logistic regression model to investigate type of surgery (amputation/bypass) (adjusted by age and sex) showed that diabetes mellitus type 2 had Odds Ratio (OR) of 3 37 this means that diabetes increase 3,37 times (CI 95%; 1,940-5,866) the risk of amputation. Total cholesterol showed a OR of 0,986, this jeans an increase of amputation 0,986 time with each mg/dl of cholesterol. Distal location increase risk of amputation 2,585 times. Patients with more than one surgery had an OR of 3,013 (1,602-5,666) to increase amputation. Each day of hospital stance increase 0,8% risk of amputation. Conclusion: In multivariant andlisis, diabetes mellitus, distal lesion, male sex and age over 75 years were positive related with stage IV and colesterol levels were inverse related. Diabetes mellitus, distal lesion, age over 75 years, days of hospital stance, number of surgeries were positive related with amputation as surgery technic and colesterol levels were negative related.