Leticia Sánchez-Reyes

Metformin's Effects on Glucose and Lipid Metabolism in Patients with Secondary Failure to Sulfonylureas

OBJECTIVE To compare results obtained with metformin versus those obtained with DNA-recombinant insulin in obese patients with NIDDM suffering from secondary failure to sulfonylureas. RESEARCH DESIGN AND METHODS We conducted an open, prospective, randomized, and comparative study comprising a total of 60 patients selected and placed in two parallel groups. We had previously confirmed that the subjects had secondary failure to high doses of sulfonylureas. The initial metformin dosage was a single 850 mg tablet, and the dosage was increased to two or three tablets depending on the patients metabolic changes. The initial dosage of DNA-recombinant insulin was 24 U, subcutaneously administered and divided into two portions: two-thirds at around 8:00 A.M., before breakfast, and the remaining third at 8:00 P.M., before dinner. The dosage was adjusted based on the patients clinical and metabolic response. RESULTS The initial average glucose value for the metformin group was 269.1 ± 32.2 mg/dl, decreasing by the end of the study to 159.7 ± 30.5 mg/dl. For the insulin group, these figures went from 270.7 ± 24.0 mg/dl at the beginning of the study to 134.8 ± 26.7 mg/dl. This decrease correlates with the reduction in glycosylated hemoglobin from 12.8 to 8.9% for the first group and from 12.3 to 8.2% for the second, as well as with the reduction in triglyceride values from 230.3 to 183.1 mg/dl and from 218.4 to 186.3 mg/dl, respectively. The BMI (27.5–26.4), blood pressure (systolic from 145.7–132.1 mmHg, diastolic from 90.3–84.8 mmHg), and total cholesterol levels (235–202 mg/dl) decreased in only the metformin group. CONCLUSIONS Metformin is an effective, safe, and well-tolerated treatment that improves metabolic control and favorably modifies secondary clinical alterations due to insulin resistance, such as arterial hypertension, overweight, and hyperlipidemia, in obese patients with NIDDM suffering from secondary failure to sulfonylureas.

Prevalencia de factores de riesgo de enfermedad coronaria en trabajadores del Hospital General de México

Objetivo. Conocer la prevalencia de algunos factores de riesgo coronario en trabajadores de una institucion de salud. Material y metodos. De 1993 a 1995 se evaluaron 2 228 trabajadores del Hospital General de Mexico, 1 531 mujeres (68.7%) y 697 hombres (31.2%) con edades entre 16 a 65 anos, y se les clasifico por areas de trabajo: en Intendencia hubo 477 participantes (21.4%); en Administracion, 697 (31.2%); en Personal Medico, 495 (22.2%), y en Enfermeria, 559 (25.0%). Se les practico historia clinica, mediciones antropometricas y determinacion de glucosa, colesterol total, LDL, HDL y trigliceridos. Resultados. Trescientos sesenta y siete sujetos (14.9%) tenian colesterol por arriba de 240 mg/dl, con valores altos en las mujeres del area administrativa (17.1%) y en los hombres del departamento de enfermeria (26%) que presento la mayor tendencia (26%). Se encontraron niveles de trigliceridos por arriba de los 200 mg/dl en 471 personas (19.1%); obesidad, en 329 (13.5%); hipertension arterial, en 549 sujetos (22.2%), y tabaquismo positivo, en 32% de los trabajadores. La prevalencia de diabetes mellitus fue de 6.24%. Conclusiones. Se confirma la elevada prevalencia de factores de riesgo de enfermedad cardiovascular entre los trabajadores del Hospital General de Mexico, factores que en muchos casos son modificables, lo que confiere la posibilidad de realizar acciones preventivas.

Safety and efficacy of sibutramine in overweight Hispanic patients with hypertension

This 6-month randomized study evaluated the safety and efficacy of sibutramine in 57 overweight Hispanic patients with hypertension. Following a 2-week washout to confirm the diagnosis of hypertension, antihypertensive medication was adjusted to achieve a blood pressure less than 140/90 mm Hg before institution of either sibutramine 10 mg or placebo once a day. A body mass index in excess of 27 kg/m2 was required for entry. At study end, weight had changed from 75.4±9.6 to 70.0±9.5 kg in the sibutramine group and from 77.9±9.0 to 74.5±9.4 kg in the placebo group. In the sibutramine group, systolic blood pressure was 127.8±5.8 mm Hg after stabilization and 125.2±8.5 mm Hg after completion of the trial; respective values for diastolic blood pressure were 82.4±3.7 and 81.5±4.6 mm Hg. With placebo, blood pressure dropped from 129.0±7.1/80.9±4.9 mm Hg to 122.8±9.7/80.3±5.4 mm Hg at the same timepoints. In the sibutramine group, 14 patients reported 21 adverse events, most frequently headache (n=5), constipation (n=4), and dry mouth (n=4). In the placebo group, 13 patients had 20 adverse events. Sibutramine is safe and effective in overweight Hispanic patients with hypertension, but monitoring of blood pressure and titration of antihypertensive medication are necessary.

PREVALENCE OF CORONARY ARTERY DISEASE RISK FACTORS IN WORKERS AT THE GENERAL HOSPITAL OF MEXICO OF THE MINISTRY OF HEALTH

OBJECTIVE To assess the prevalence of coronary risk factors in 2,463 health-care workers at the General Hospital of Mexico. METHODS The study participants--1,620 women (65.8%) and 843 men (34.2%)--ranged in age from 16 to 65 years old. Study subjects were classified into five occupational subgroups: maintenance workers, 477 (19.4%); administrators, 697 (28.3%); physicians, 495 (20.1%); nursing staff, 559 (22.7%); and students, 235 (9.5%). For each participant, a clinical history was elicited, anthropometric determinations were done, and samples were obtained for determining blood glucose, total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels. RESULTS Cholesterol levels above 6.2 mmol/L (>240 mg/dL) were found in 14.9% of the women and 14.8% of the men in the overall study group. Triglyceride levels of more than 2.25 mmol/L (>200 mg/dL) were found in 471 participants (19.1%). The prevalence of obesity was 13.5%, and high blood pressure was detected in 22.2% of study participants. Only 32.2% of subjects engaged in physical exercise one or more times per week; moreover, 32% of those surveyed smoked. The prevalence for diabetes mellitus was 6.25%. The multifactorial coronary risk index was high in 13.2% of men and 43.2% of women older than 30 years of age. CONCLUSION This study confirmed the high prevalence of risk factors for cardiovascular diseases in personnel of the General Hospital of Mexico. Because many of these risk factors are modifiable, educational efforts and preventive measures should be implemented.