Mileni Josefina Maria Ursich

Ultrasonographic Abnormalities of the Pancreas in IDDM and NIDDM Patients

Objective— To evaluate the relationship between the type and duration of diabetes and pancreas size by ultrasonography. Research Design and Methods— Pancreas images of 40 IDDM and 36 NIDDM patients with 0.3–34 yr of disease were compared with those of 60 normal healthy control subjects. Results— The diameters ± SD of the head, body, and tail of the pancreas in IDDM patients (1.9 ± 0.3; 0.9 ± 0.2; and 1.4 ± 0.2 cm, respectively) were smaller than in NIDDM patients (2.7 ± 0.4; 1.2 ± 0.3; and 1.8 ± 0.4 cm, respectively) and control group subjects (2.4 ± 0.4; 1.1 ± 0.3; and 1.8 ± 0.4 cm, respectively). The pancreatic shrinkage in IDDM patients was clearly evident after 10 yr of the disease. NIDDM patients and control subjects had similar pancreatic dimensions, except for a greater body thickness in NIDDM patients with >10 yr of disease (1.2 ± 0.4 vs. 1.1 ± 0.3 cm). These results were not related to differences in age, sex, and body size. Pancreas image was hypoechogenic in 72.5% of IDDM patients and hyperechogenic in 83.3% of NIDDM patients. Conclusions— Smaller pancreases in IDDM patients in comparison with NIDDM patients and control subjects were clearly demonstrated only after 10 yr of disease. Patients with NIDDM were not affected by pancreatic dimensions, except for a greater body thickness after 10 yr of disease. Pancreatic echogenicity increased with age.

Association of acanthosis nigricans with race and metabolic disturbances in obese women

Acanthosis nigricans (AN) has been recognized as a marker of insulin resistance and diabetes mellitus. We have compared frequency of race and metabolic disturbances in obese women with several degrees of AN (AN group, N = 190) to a group without AN (non-AN group, N = 61) from a mixed racial population. The groups were similar regarding age and body mass index. All patients (except the diabetic patients) underwent an oral glucose tolerance test (75 g). The racial distribution of this population was 35.1% white, 37.8% mulatto and 27.1% black and the frequency of AN was 62.5, 82.1 and 83.8%, respectively, higher in black versus white (P = 0.003) and mulatto versus white (P = 0.002) women. The frequencies of diabetes mellitus and impaired glucose tolerance were 5.8 and 12.6% in the AN group and 1.6 and 8.2% in the non-AN group, respectively (P>0.05). Fasting glucose, beta cell function determined by the homeostasis model of assessment (HOMA), fasting insulin and insulin area under the curve were similar for the AN and non-AN groups. A higher HOMA insulin resistance was observed in the AN group compared to the non-AN group (P = 0.02) and in the subgroup of highest degree of AN compared to those with other degrees. The mean lipid levels and the frequency of dyslipidemia were similar for the two groups. AN was strongly associated with the black or mulatto rather than the white race, even after taking into account the effect of age, body mass index and HOMA insulin resistance.

Insulin resistance in limb and trunk partial lipodystrophy (type 2 Köbberling-Dunnigan syndrome)

We studied insulin action in two patients with limb and trunk partial lipodystrophy with hirsutism and acanthosis nigricans. Glucose was normal in one of the patients and slightly above normal in the other during an oral glucose tolerance test (OGTT). An intravenous glucose tolerance test (IVGTT) was normal in both patients. Basal and glucose-stimulated insulin levels were elevated in both the OGTT and IVGTT in both patients. The response of plasma glucose to exogenously administered insulin was decreased. A euglycemic-hyperinsulinemic clamp performed in patient no. 2 indicated insulin resistance, which was not corrected by reducing the increased basal level of serum free fatty acids (FFAs). Binding of insulin to neck adipocytes was normal in both subjects, but glucose transport and oxidation in these cells was impaired. Insulin binding to abdominal adipocytes was increased in one patient whose adipocytes displayed higher glucose transport at low insulin concentrations. Glucose oxidation was decreased in abdominal adipocytes of both patients. We conclude that insulin resistance in Köbberling-Dunnigan type 2 partial lipodystrophy is not related to an alteration of the insulin molecule or to changes in insulin binding, but is more likely associated with a postreceptor defect, since glucose oxidation was impaired in adipocytes of the neck and abdomen.

Cardiovascular, metabolic and hormonal responses to the progressive exercise performed to exhaustion in patients with type 2 diabetes treated with metformin or glyburide.

Objectives:  To evaluate the effects of Metformin and Glyburide on cardiovascular, metabolic and hormonal parameters during progressive exercise performed to exhaustion in the post‐prandial state in women with type 2 diabetes (T2DM).

Acanthosis nigricans em mulheres obesas de uma população miscigenada: um marcador de distúrbios metabólicos

< 0,01), mais obesas (41 ± 6 versus 39 ± 6 kg/m 2 , p<0.01), tinham maior circunferencia de cintura, maior frequencia de obesidade androide, de diabetes tipo 2 (11,1% versus 4,3%, p=0,05), maiores niveis de insulina de jejum e de resistencia insulina (Homa IR) do que aquelas sem AN. As frequencias de hipertensao diastolica e alteracoes do colesterol total e fracoes e de triglicerides entre os grupos foram similares. C ONCLUSAO - Em mulheres obesas de uma populacao miscigenada, AN foi mais frequente nas de raca negra e parda e foi observada maior frequencia de co-morbidades da sindrome metabolica em comparacao a populacao sem AN. As mulheres obesas com AN devem ser investigadas para disturbios metabolicos, mesmo sendo jovens. Palavras-chaves: Acantose nigricans; diabetes mellitus nao insulino-dependente; metabolismo; obesidade; racas; resistencia a insulina. Summary: BACKGROUND - Acanthosis nigricans (AN) has been associated with various metabolic and endocrine disturbances. O BJECTIVE: The objective of this study is to evaluate the frequency of metabolic syndrome clusters in a group of obese mixed-race women with

The effects of metformin and glibenclamide on glucose metabolism, counter-regulatory hormones and cardiovascular responses in women with Type 2 diabetes during exercise of moderate intensity.

Aims  To compare the effects of metformin and glibenclamide on cardiovascular, metabolic and hormonal parameters during exercise of moderate intensity performed in the postprandial state, in women with Type 2 diabetes.

Diabetes autoimune em adultos: características clínicas e autoanticorpos

The prevalence of anti-insulin (IAA), anti-glutamic acid decarboxylase 65 (anti-GAD) and anti-islet cell antibodies (ICA) and the clinical and metabolic findings of 66 patients with adult-onset diabetes mellitus (DM) manifested at 47.2±11.6 years with known duration of 14.3±8.4y were determined. RESULTS: ICA was positive in 10 cases (10 to 640 JDF U), 3 of them being also positive for anti-GAD (15.6 to 113.5 U/ml) and one for IAA (in those without previous insulin therapy). 15.2% of the patients had one or more autoantibodies, with greater prevalence for ICA. There were no differences between patients with and without autoantibodies for clinical DM presentation and prevalence of chronic complications. Only the cholesterol levels were lower in the antibody positive group (205.2±49.6 vs. 247.1±61.3mg/dl; p<0.05). CONCLUSION: 15.2% of the adult-onset DM had one or more autoantibodies, with greater prevalence for ICA. Autoantibodies determination is necessary for the diagnosis of autoimmune DM.