José Antonio Robles-Cervantes

Effect of Resveratrol Administration on Metabolic Syndrome, Insulin Sensitivity, and Insulin Secretion

BACKGROUND The aim of this study was to evaluate the effect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretion. METHODS A randomized, double-blind, placebo-controlled clinical trial was carried out in 24 patients with a diagnosis of metabolic syndrome. Glucose and insulin levels after a dextrose load were measured. Triglycerides and high-density lipoprotein cholesterol concentrations at baseline were also measured. Twelve patients received berberine hydrochloride (500 mg) three times daily before meals for 3 months. The remaining 12 patients received placebo. Area under the curve (AUC) of glucose and insulin, total insulin secretion, first-phase of insulin secretion, and insulin sensitivity were assessed. RESULTS After berberine administration, patients had a remission of 36% (P=0.037) in the presence of metabolic syndrome and a significant decrease in waist circumference in females (106±4 vs. 103±3 cm, P<0.05), systolic blood pressure (SBP) (123±7 vs. 115±9 mmHg, P<0.01), triglycerides (2.4±0.7 vs. 1.4±0.5 mmol/L, P<0.01), area under the curve (AUC) of glucose (1182.1±253.6 vs. 1069.5±172.4 mmol/l, P<0.05), AUC of insulin (92,056±72,148 vs. 67,407±46,441 pmol/L, P<0.01), and insulinogenic index (0.78±0.69 vs. 0.62±0.46, P<0.05), as well as an increase in the Matsuda index (2.1±1.0 vs. 3.1±1.6, P<0.01). CONCLUSIONS Administration of berberine leads to remission of metabolic syndrome and decreases in waist circumference, SBP, triglycerides, and total insulin secretion, with an increase in insulin sensitivity.

Effect of Diacerein on Insulin Secretion and Metabolic Control in Drug-Naïve Patients With Type 2 Diabetes: A randomized clinical trial

OBJECTIVE To assess the effect of diacerein on insulin secretion and metabolic control in drug-naïve patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A randomized, double-blind, placebo-controlled clinical trial was carried out in 40 drug-naïve adult patients with type 2 diabetes. A metabolic profile including interleukin (IL)-1β, tumor necrosis factor-α, IL-6, and fasting insulin levels was carried out before the intervention and 2 months afterward. A hyperglycemic-hyperinsulinemic clamp technique was performed to assess the phases of insulin secretion and insulin sensitivity. After randomization, 20 patients received diacerein (50 mg once daily) for the first 15 days and twice daily for 45 additional days. The remaining patients received placebo. Intra- and intergroup differences were calculated by Wilcoxon signed rank and Mann-Whitney U tests. RESULTS There were significant increases in first (102 ± 63 vs. 130 ± 75 pmol/L; P < 0.01), late (219 ± 111 vs. 280 ± 135 pmol/L; P < 0.01), and total insulin (178 ± 91 vs. 216 ± 99 pmol/L; P < 0.01) secretions without changes in insulin sensitivity after diacerein administration. There were significant decreases in fasting glucose (7.9 ± 1.4 vs. 6.8 ± 1.0 mmol/L; P < 0.01) and in A1C levels (8.3 ± 1.0 vs. 7.0 ± 0.8%; P < 0.001) after diacerein administration. There were no significant changes after placebo administration in the above-mentioned evaluations. CONCLUSIONS Insulin secretion increased and metabolic control improved after diacerein administration in drug-naïve patients with type 2 diabetes.

Chitosan improves insulin sensitivity as determined by the euglycemic-hyperinsulinemic clamp technique in obese subjects

In accordance with obesity is associated with insulin resistance and dyslipidemia and chitosan decrease weight and lipids, but its effect on insulin sensitivity is unknown. Our hypothesis for the research was that chitosan improves insulin sensitivity estimated with the euglycemic-hyperinsulinemic clamp technique in obesity. We undertook this study with the objective to determine the effect of chitosan on insulin sensitivity using the euglycemic-hyperinsulinemic clamp technique in obese patients during a 3-month period. A randomized, double-blind clinical trial was carried out in 12 obese adults without diabetes mellitus. During a 3-month period, 6 patients received chitosan (750 mg, 3 times per day) 30 minutes before meals, and the other 6 subjects received placebo. Serum glucose, total cholesterol, high-density lipoprotein cholesterol, and triglycerides (TG) were measured. Insulin sensitivity was estimated with the euglycemic-hyperinsulinemic clamp technique before and after the intervention. Insulin sensitivity increased significantly with the administration of chitosan (2.4 +/- 1.4 vs 3.6 +/- 1.4 mg kg(-1) min(-1); P = .043). In addition, there was a decrease in weight (90.7 +/- 14.2 vs 84.7 +/- 13.7 kg; P = .027), body mass index (34.3 +/- 2.7 vs 31.6 +/- 2.2 kg/m(2); P = .028), waist circumference (106 +/- 12 vs 99 +/- 9 cm; P = .028) and TG (2.4 +/- 0.9 vs 1.6 +/- 0.9 mmol/L; P = .028) in the chitosan group. In conclusion, 3-month administration of chitosan increased insulin sensitivity in obese patients and demonstrated a decrease in weight, body mass index, waist circumference, and TG.

Effect of surgically removing subcutaneous fat by abdominoplasty on leptin concentrations and insulin sensitivity.

The aim of this study was to identify the effect of surgically removing subcutaneous fat by abdominoplasty on leptin concentrations and insulin sensitivity. An open clinical trial with a noninterventional parallel group was carried out in 12 obese women. After randomization, 6 volunteers were selected for abdominoplasty, and the other 6 women were considered as the noninterventional group. A metabolic profile, including leptin concentrations, and insulin tolerance test to assess insulin sensitivity were performed on all volunteers before intervention or nonintervention and 40–50 days afterward. A significant reduction in body mass index (30.7 ± 0.9 versus 29.6 ± 0.7 kg/m2; P = 0.02) and in leptin concentrations (41.3 ± 10.6 versus 32.0 ± 10.2 ng/mL; P = 0.02) was observed after abdominoplasty. Insulin sensitivity did not change after intervention. In conclusion, surgically removing subcutaneous fat by abdominoplasty decreased leptin concentrations, with no change in insulin sensitivity.

Effect of Metformin Glycinate on Glycated Hemoglobin A1c Concentration and Insulin Sensitivity in Drug-Naive Adult Patients with Type 2 Diabetes Mellitus

AIM This study evaluated the effect of metformin glycinate on glycated hemoglobin A1c (A1C) concentration and insulin sensitivity in drug-naive adult patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS A randomized, double-blind, placebo-controlled clinical trial was carried out in 20 patients with drug-naive T2DM. Ten subjects received metformin glycinate (1,050.6 mg) once daily during the first month and force-titrated twice daily during the second month. Ten additional patients received placebo as the control group. Before and after the intervention, metabolic profile including A1C and insulin sensitivity (euglycemic-hyperinsulinemic clamp technique) was estimated. RESULTS A1C concentrations decreased significantly with metformin glycinate administration (8.0 ± 0.7% vs. 7.1 ± 0.9%, P = 0.008) before and after the intervention, respectively. There were significant differences in changes from baseline of A1C between groups (0.0 ± 0.7% vs. -1.0 ± 0.5% for placebo and metformin glycinate groups, respectively; P = 0.004). A reduction of ≥1% in A1C levels was reached in 60.0% of patients with metformin glycinate administration (P = 0.02). Insulin sensitivity was not modified by the intervention. CONCLUSIONS Administration of metformin glycinate during a 2-month period showed a greater decrease in A1C concentrations than placebo in a selected group of drug-naive adult patients with T2DM.

Effect of Exenatide on Fat Deposition and a Metabolic Profile in Patients with Metabolic Syndrome

BACKGROUND The aim of this study was to evaluate the effect of exenatide on fat deposition and a metabolic profile in patients with metabolic syndrome. METHODS An uncontrolled, open clinical study was carried out in 10 patients with metabolic syndrome and without pharmacological treatment. Patients received exenatide (5 μg) subcutaneously twice daily for 1 month. Before and after the intervention, metabolic profile and phases of insulin secretion and insulin sensitivity were estimated. To assess insulin secretion and sensitivity, the hyperglycemic-hyperinsulinemic clamp technique was performed. Computed tomography was performed to evaluate both subcutaneous and visceral fat. The Wilcoxon signed-rank test and Mann-Whitney U-test were used for statistical analyses. RESULTS Weight, body mass index, waist circumference, and systolic blood pressure were decreased by exenatide. Subcutaneous fat deposition decreased by 4.4% compared to the basal value. There were significant decreases in total cholesterol and low-density lipoprotein cholesterol, as well as an increment in the first phase of insulin secretion after the intervention. CONCLUSION One-month administration of exenatide significantly decreased subcutaneous fat deposition by 4.4%, improving the metabolic profile in patients with metabolic syndrome.

Aesthetic plastic surgery training at the Jalisco Plastic and Reconstructive Surgery Institute: a 20-year review.

Background: Teaching aesthetic surgery within the different training programs worldwide sometimes presents significant challenges. The main difficulty lies in providing resident physicians with sufficient exposure to all of the conditions that they will likely encounter once their training ends. In many places, exposure to a totally comprehensive array of operations is almost nonexistent. Methods: To analyze the work that residents perform in aesthetic surgery at the Instituto Jalisciense de Cirugía Reconstructiva “José Guerrerosantos” (Jalisco Plastic and Reconstructive Surgery Institute), a hospital affiliated with the University of Guadalajara in Jalisco, Mexico, the surgical records of 30 residents who finished their plastic surgery training between 1990 and 2009 were chosen at random and reviewed retrospectively. Only surgical procedures performed in operating rooms, in which residents acted as the primary surgeon or first assistant, were analyzed. Results: Each resident performed an average of 309 aesthetic surgical procedures: 167 as surgeon and 142 as first assistant. The surgical procedures were divided into three general categories: body contouring procedures, breast procedures, and facial procedures. The numbers of procedures performed by residents as surgeons or first assistants according to each category were 55 and 37 (body contouring), 34 and 31 (breast), and 78 and 74 (facial). Conclusions: The experience is gratifying. At the Jalisco Plastic and Reconstructive Surgery Institute, all residents have an opportunity to perform a comparable number of aesthetic procedures of the most varied nature and complexity under the supervision of experienced plastic surgeons. It is therefore possible to teach aesthetic surgery to residents.

Behavior of visfatin in nonobese women undergoing liposuction: a pilot study.

INTRODUCTION The adipocyte has recently begun to be considered not just as a fat deposition tissue, but also as a true endocrine organ. Adipose tissue produces a wide variety of adipocytokines, of which visfatin is one. OBJECTIVE Since visfatin has recently been described as a mimic of insulin action, the authors evaluate visfatin behavior in women undergoing liposuction. MATERIALS Nineteen nonobese women underwent liposuction of abdominal fat. Patient visfatin levels and a lipid profile were obtained preoperatively, and the results were compared with the results of the same tests immediately postoperatively and one month postoperatively. RESULTS The mean age of the 19 study participants was 33 years; mean body mass index was 24.7±2.2 kg/m2. The amount of subcutaneous fat obtained was an average of 4468±1403 kg. Visfatin increased from 51.8±24.4 ng/mL preoperatively to 76.3±39.8 ng/mL (P=.02). Pre- and postoperative lipid profiles reflected, respectively, the following: total cholesterol, 159.1±37.1 vs 164.6±31.7 mg/dL (P=.420); high-density cholesterol, 41.4±8.6 vs 39.3±9.9 mg/dL (P=.421); low-density cholesterol, 97.1±25.4 vs 100±19.2 mg/dL (P=.507); and triglycerides, 92.3±57.1 vs 126.3±72.5 mg/dL (P=.058). CONCLUSIONS Visfatin levels were shown to increase after liposuction of subcutaneous fat. The authors conclude that this adipocyte may play an important role as a regulatory reciprocal mechanism.

Effect of 2 Liquid Nutritional Supplements for Diabetes Patients on Postprandial Glucose, Insulin Secretion, and Insulin Sensitivity in Healthy Individuals

AIM To compare the effect of 2 liquid nutritional supplements (Enterex Diabetic and Glucerna SR) designed for the patient with diabetes mellitus on postprandial glucose, insulin secretion, and insulin sensitivity in healthy individuals. PATIENTS AND METHODS A randomized, double-blind, crossover clinical trial was carried out in 14 healthy, young (average age 21.7+/-2.8 years) volunteers. Each individual received a single administration of 232 kcal in 232 mL of Enterex Diabetic or in 237 mL of Glucerna SR. Three days later, the intervention was crossed using the opposite supplement. At the beginning of each administration and later at 30, 60, 90, and 120 minutes, glucose and insulin concentrations were measured. Triglyceride concentrations were measured at the beginning and at 120 minutes. Area under the curve of glucose and insulin was calculated. First-phase and total insulin secretion, as well as insulin sensitivity, were assessed. RESULTS Glucose concentration at 120 minutes was significantly lower after the administration of Enterex Diabetic in comparison with Glucerna SR (4.3+/-0.6 vs 4.7+/-0.4 mmol/L; P=.012). Enterex Diabetic compared with Glucerna SR showed a greater change of the glucose concentration from 0 to 120 minutes (-0.7+/-0.6 vs -0.0+/-0.4 mmol/L; P=.002). Administration of Enterex Diabetic decreased insulin concentrations at 120 minutes (60+/-18 vs 48+/-19 pmol/L; P=.013). Administration of Glucerna SR increased triglyceride concentration at 120 minutes (1.0+/-0.3 vs 1.1+/-0.4 mmol/L; P=.026). CONCLUSION A single administration of Enterex Diabetic in healthy individuals decreased glucose and insulin concentrations at 120 minutes without any modification in triglyceride levels.

Insulin resistance in adult primary care patients with a surrogate index, Guadalajara, Mexico, 2012.

Introduction Insulin resistance (IR) is a key molecular disorder related with diabetes mellitus, obesity, and cardiovascular disease. The objective of this study was to determine IR in adult primary care patients using the triglyceride/glucose (TyG) index [(Ln TG (mg/dL) × FG (mg/dL))/2]. Methods We conducted a cross-sectional secondary analysis and identified IR subjects according to the TyG index. Results There were 1500 patients included. Significant differences were found between the IR group versus the insulin-sensitive group, respectively: age (in years), 46.4 ± 9.34 versus 40.24 ± 11.27 (P < 0.001); fasting glucose (mg/dL), 99.87 ± 11.95 versus 84.62 ± 6.59 (P < 0.001); total cholesterol (mg/dL), 203.21 ± 37.38 versus 173.91 ± 33.99 (P < 0.001); triglycerides (mg/dL), 226.40 ± 96.66 versus 111.27 ± 23.44 (P < 0.001); uric acid (mg/dL), 6.09 ± 1.59 versus 4.77 ± 1.40 (P < 0.001); and TyG index, 4.96 ± 0.21 versus 4.48 ± 0.13 (P < 0.001). The cutoff of the TyG index for IR was 4.68 or greater. Conclusions The TyG index allows for early diagnosis of IR in primary health care.