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Background: Metformin is considered to be the drug of choice in overweight, newly diagnosed type 2 diabetes. Lactic acidosis is stated to be the most serious side effects of metformin therapy. Current available guidelines contain so many ambiguous terms in describing the contraindications to metformin use that they do little to assist in addressing this problem. Moreover, these ambiguous contraindications may deprive many diabetic patients from the benefit of metformin. Objectives: The aim of the current study was to evaluate the safety of metformin use in the presence of “standard” contraindications to its use. Research design and methods: This was a cross sectional study that involved type 2 diabetic patients who were on chronic treatment with metformin. A fasting blood sample was taken from each subject to determine levels of serum creatinine levels, bicarbonate, fasting blood sugar, lactate, insulin, C-Peptide, and metformin plasma concentration. Results: 106 patients were recruited in the study with 68 (64%) females. The mean age was 58 ± 13 years. The results illustrate that metformin has been prescribed for patients who are listed in the guidelines as having standard contraindications to its use. There were 30 (28%) patients with impaired renal function (Clcr < 60ml/min.) and five with Clcr < 30ml/min. Moreover, 30 (28%) had ischemic heart disease, six (5%) patients were diagnosed as having congestive heart failure, five (4%) with chronic obstruction pulmonary disease, and three (2%) with peripheral vascular disease. Although the numbers of those patients were not large enough to establish and confirm the safety of metformin in the presence of these standard contraindications and precautions, there were no cases of lactic acidosis observed. Conclusions: This study along with other studies has revealed that there is vagueness in the available guidelines in prescribing metformin, which led to the different observed practices. This study revealed that metformin is still prescribed to patients with listed contraindications. Clearer guidelines are needed for prescribing metformin with more specific contraindications. For example it would be more beneficial if the degree of heart failure, classified according to the New York Heart Association is specified.

The levels of tissue kallikrein are reduced in humans with hypertension, cardiovascular and renal diseases. There is little information on the participation of human tissue (renal/urinary) kallikrein (hK1) in type 1 diabetes mellitus (DM), and, no information concerning the role of hK1 was reported in gestational diabetes mellitus (GDM). The present study evaluated the roles of insulin and hyperglycemia on urinary hK1 activity in type 1 DM and in GDM. Forty three type 1 DM patients (535 years, disease duration  5 years, receiving insulin, HbA1c > 7.6%) were selected. Forty three healthy individuals, paired according to gender and age, were used as controls. Thirty GDM patients (18−42 years, between the 24th and 37th weeks of pregnancy, recently diagnosed, not under insulin therapy) were also selected. Thirty healthy pregnant and thirty healthy non−pregnant women (18−42 years) were selected as controls. A random midstream urine was used. hK1 amidase activity was estimated with D-Val-Leu-Arg-Nan substrate. Albumin was determined with Coomassie Brilliant Blue reagent. Creatinine was determined by Jaffe's method. hK1 specific amidase activity was expressed as μM/(min/mg creatinine to correct for differences in urine flow rate. hK1 specific amidase activity was significantly higher in the urine of type 1 DM and GDM patients, respectively, than in controls. These findings suggest that hyperglycemia rather insulin is involved in the mechanism of increased hK1 specific amidase activity in the urine of both type 1 DM and GDM patients. Albumin/creatinine ratio was increased in type 1 DM, GDM and healthy pregnant women.

Hearing impairment is a late complication of diabetes mellitus (DM). The present study was needed considering high incidence of diabetes in Indian population and its complications in the form of hearing loss. Delay in the neural conductance along the auditory pathway due to DM was assessed by means of Auditory Brainstem Response (ABR). The sample comprised of three groups, first group comprising of normal healthy 16 ears, the second group with type 1 DM and the third group with type 2 DM comprising of 16 ears each, respectively. ABR recordings showed that absolute latencies of waves I, III, and V that were significantly prolonged in the diabetic group compared to control (p<0.05). However, when two diabetic groups were compared with each other, the difference between latencies of waves I, V in the two diabetic groups was statistically significant (p<0.05). With increase of stimulus presentation rate from 20/s to 72/s in type 2 DM, there was a significant delay in absolute latencies of wave I, III, V as well as interpeak latencies of waves III-V, and I-V. There is a delay in neural conductance due to DM which can be measured using ABR even before manifestation of actual hearing loss.The prolongation of latency of ABR in diabetic patients should raise concern about damage to the auditory nerve. A close follow up will be required in these patients.

Background: Obesity is becoming a severe health problem worldwide. We evaluated the prevalence of obesity in different regions of Turkey, to study the association between BMI and regional nutritional habits and to compare the results with previous epidemiological studies. Method: 13,878 individuals (6,799 males and 7,079 females) were screened in six different regions of Turkey between 2000-2005 (Istanbul and Kastamonu from Northern part of the country, Gaziantep from South, Denizli and Kırklareli from the West and Konya from the middle part of the country). The sample was randomly selected and all participants were older than 20 years of age. Weight (kg), height (cm) and waist circumference (cm) were measured and body mass index (BMI) was calculated according to World Health Organization (WHO) methods and criteria. Results: The mean BMI was 27.52 kg/m2, 26.80 kg/m2 in men and 28.24 kg/m2 in women. The mean waist circumference was 98.5 cm in men and 79.8 cm in women. 30.9% of the subjects have normal weight, 39.6 % were overweight, and 29.5% were obese according to the WHO classification. The highest prevalence (39.9%) of obesity was observed between the ages of 50-59 years. The prevalence of obesity was highest in Gaziantep (41.6%), which is an industrialized city in the southeastern part of the country. The prevalence of overweight in men aged from 60-69 years was 49.7% and was 37.2% in women between the ages of 30-39 years. The highest frequency of obesity for men was 27.9 % in the 50-59 years age group whereas the highest frequency of obesity for women was 51.4 %) in the 50-59 years age group. A heterogenous set of results were obtained with respect to lifestyles and nutritional habits for every city when the prevalence of overweight and obesity in the age groups were evaluated according to regions. Conclusion: Obesity is a major health problem in Turkey and the increased prevalence of obesity in the young age group raises concern.

The prolonged use of retinoids is associated with changes in bone turnover markers and toxic skeletal effects. Although the effect of short-term oral isotretinoin therapy on bone loss is not well established, caution is recommended when it is used in patients with metabolic bone disease. We examined prospectively the effect of short-term oral isotretinoin therapy on bone turnover markers and bone mineral density (BMD) in women affected by severe acne and vitamin D deficiency. Serum bone Tartrate-resistant Acid Phosphatase (TRACP), bone specific alkaline phosphatase (Bone ALP), calcium, phosphorus, parathyroid hormone (PTH) and 25-hydroxyvitamin D [25(OH)D] were measured in 10 women at baseline, 6 weeks, and end of isotretinoin treatment. BMD was measured in 5 subjects at baseline and end of treatment. Mean serum 25(OH)D at baseline was 16.3  7.5 nmol/L. Mean TRACP and Bone ALP increased at end of treatment but this was only statistically significant for TRACP (1.18, 1.13, 1.64 U/L; P<0.001). Mean calcium decreased slightly at end of treatment but no significant changes occurred in PTH, 25(OH)D and phosphorus. BMD decreased in all studied patients at the femur (range -2.5 to -7.6%), and in all but one patient at the lumbar spine (range +3.2 to -6.8%). Mean BMD decreased at all measured sites but this was statistically significant only for the femur (-5.3  1.9%; P=0.002). Our preliminary study suggests that short-term oral isotretinoin therapy in women with vitamin D deficiency is likely associated with increased bone resorption and decreased BMD. Correction of vitamin D deficiency may be necessary before starting isotretinoin therapy.

Objective: To estimate the prevalence of diabetes mellitus (DM), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT), and to determine the risk factors of DM among urban and rural areas of Kinshasa Hinterland. Research, Design and Methods: Data were collected from a multistage random sample cross-sectional surveys of adult black Africans from Kinshasa region DR Congo with the help of a structured questionnaire, physical examinations and blood samples, using the WHO stepwise approach and the new criteria of WHO to define glucose intolerance. Prevalence rates were adjusted using the standard world population of Waterhouse and the standard population of Kinshasa region. Results: A total of 9770 subjects age ≥ 12 years participated (response rate of 90.3%) in this study. Age-adjusted rates to world population of IFG, IGT, DM by fasting plasma only, DM by 2h-load test only, and all cases of DM were 9.3%, 9.6%, 16.1%, 8.4% and 25.3%, respectively. Male sex, rural residence, total obesity, abdominal obesity, viral infection, milk intake, and kwashiorkor were the univariate risk factors of all cases of DM. Adjusted for confounders, advancing age, rural-urban migration, physical inactivity, smoking, abstinence of alcohol, low intake of fruits-vegetables, family history of DM, refined sugar intake, high social class, high intake of animal fat and protein, and stress, were the independents determinants of all cases of DM. Conclusions: This study observed epidemic rates of glucose intolerance. Primary prevention through lifestyle changes is needed to control DM among Africans under demographic and nutrition transition.

Objective: to assess the prevalence and the risk factors of diabetic retinopathy (DR) in urban diabetics from Kinshasa, DRC. Methods: this is a community-based cross-sectional survey and a case-control study on diabetic retinopathy in Kinshasa, the capital of DRC. The medical charts of all diabetics (n=3010) ≥ 20 years were studied to estimate the prevalence of DR during November 2004. 10% (n=301) of these were randomly selected to reveal 95 diabetics with DR and 206 diabetics without DR (control). Both groups were matched for primary care centre, sex, age, body mass index, and waist circumference, attending the primary care centres between December 2004 and December 2005, and were screened for DR using stereo color photography and ophthalmoscopy. Results: the overall prevalence rate of DR in the population was 31.6% (n=950 95% confidence interval [CI]:26.3 – 36.9). Delayed diagnosis of diabetes (≥55 years) in the study sample in women, men with high socioeconomic status, and pregnancy onset after the diagnosis of DR among women, were identified as variables for Univariate analysis and for significant risk factors of DR. Logistic regression analysis showed that longer duration of diabetes (≥4years) (LDD), systolic arterial hypertension (SAH), higher pulse pressure (≥60 mmHg, clinical pre-atherosclerosis/arterial stiffness), and family history of diabetes (FHD), were the significant and independent determinants of DR in the sample study. The multivariate risk of DR conferred by these determinants is enhanced among female diabetics (y=2.679 + 1.528 SHT + 1.080 LDD + FHD; p<0.01) and patients with type 2 diabetes (y=2.725 + 1.316 SHT + LDD + 1.246 FHD; p<0.05). The adjusted odds-ratio for DR conferred by higher pulse pressure was 5 (95% CI 2 – 12.8; p<0.05. Conclusion: Longer duration of diabetes, arterial systolic hypertension, and higher pulse pressure (arterial stiffness) were the most significant independent risk factors of diabetic retinopathy. However, a population-based study is warranted to identify the risk factors, as well as the prevalence of diabetic retinopathy.

Objective: To determine the effect of two regimens of oral hypoglycaemic agents: sulphonylurea monotherapy and metformin in combination with sulphonylurea on arterial stiffness. Methods: A case control study was conducted at the Family Medicine and Diabetic Clinic, HUSM from May 2004 until May 2005. Sixty subjects receiving sulphonylurea alone and ninety subjects on combination therapy with metformin participated in this study. A simple random sampling method using a draw lot was used to select 51 subjects for each group. Augmentation index (AI) was measured using the Sphygmocor apparatus and all measurements were performed by the investigators after an earlier validation study. The mean augmentation index measurements were analyzed. Results: The mean AI values of diabetic subjects treated with sulphonylurea monotherapy and a combination with metformin were 140.51 ± 11.42 vs 140.14 ± 12.86, p= 0.877. AI values were significantly higher in females compared with males (143.23 ± 10.60 vs 135.82 ± 13.01, 95% CI: -12.07, -2.73, p = 0.002). Duration of diabetes (in years) was significantly less (3.46 ± 3.16 vs 5.41 ± 3.66, p = 0.005) for sulphonylurea monotherapy patients compared with combination therapy patients. Conclusion: This study shows that sulphonylurea monotherapy and metformin in combination with sulphonylurea have similar effects on arterial stiffness in type 2 diabetes subjects. Diabetes is associated with a greater arterial stiffness in women compared with men.

An open label study was conducted to asses the efficacy and safety of rosiglitazone when administered concurrently with sulphonylurea compounds. Sixty-three type 2 diabetic patients were enrolled in the study in three different centres across Nigeria, Zaria in the north, Lagos in the southwest and Port Harcourt in the southeast. Nigeria is a large country with multiethnic groups. Subjects were randomly divided into two treatment groups; one on only sulphonylurea and the other on rosiglitazone (4 mg daily) for 26 weeks in addition to the current dose of sulphonylurea. Fifty-two subjects (82.5%) completed the study. The addition of rosiglitazone to sulphonylurea therapy resulted in more steady control of fasting plasma glucose (FPG) over time, higher mean change in FPG from baseline and higher proportion of subjects recording HBA1C value of <7.5. There were no significant adverse events attributable to rosiglitazone therapy during the 26 weeks of therapy. It is concluded that the addition of rosiglitazone to sulphonylurea treatment is safe and has a synergistic effect in controlling glycaemia in type 2 diabetic patients. (Int J Diabetes Metab 15:62-67, 2007)

Inadequate glycaemic control in Jamaican adults with type 2 diabetes mellitus (DM) prompted assessment of glycaemic control, oxidative stress, cardiovascular (CV) and renal risk in adults attending a hospital clinic. A random sample of 133 patients men (n=35) and women (n=98), with diabetes mellitus was selected from a population of 510 patients. Fasting blood samples (n=122) were evaluated for metabolic control and dyslipidaemia. Oxidative stress was evaluated by measurement of urinary F2 isoprostane (n=124). The data were analysed using SPSS. The mean age of the participants was 56.7 ± 14.3 years, with mean duration of diabetes of 12.2 years. Mean fasting blood sugar was 8.6 ± 4.3 mmol/L. 77% of patients had HbA1c > 6.5%. 69% of patients were being treated with insulin with no difference in HbA1c levels in these patients compared to those receiving other hypoglycaemic agents. 90% of men (median 1004pg/mg creatinine) and 99% of women (median 1501.3pg/mg) had isoprostane levels above the median for subjects with CV risk. 54% of patients had total cholesterol levels ≥ 5.2 mmol/L, 16% triglyceride levels ≥ 1.5 mmol/L, 25% HDL levels ≤ 1.0mmol/L and 86% LDL ≥ 2.5mmol/L. 63 % of patients had BP >130/85 mmHg. 81% were overweight or obese, with 80% of the men having waist circumferences >88 cm, whereas 87% of the women had waist circumferences of 84.5cm. Microalbuminuria was increased in 37% of the subjects. The high prevalence of overweight, central obesity, elevated LDL and hypertension in these patients indicated high CV and renal risk. The risk was significantly higher in persons with inadequate glycaemic control. Isoprostane levels were high in the majority of subjects but did not correlate with HbA1c or any other variable. (Int J Diabetes 14: 51-54, 2006 )

The pentapeptide enterostatin (Val-Pro-Asp-Pro-Arg or VPDPR1) has been shown to inhibit insulin secretion both in vivo and in isolated rat islets. We report on structure-function studies of enterostatin in rat islets and in RINm5F insulinoma cells. In isolated rat islets, the tyrosinated version of enterostatin (YVPDPR) had ~10 fold reduced potency at lower concentrations (10nM versus 1nM) in inhibiting insulin release compared to nascent enterostatin and did not exhibit activity at 1μM concentrations. Replacement of the L-valine with D-valine caused total loss of biological activity. The peptide YPDPR was more efficacious than native enterostatin at 0.1nM but lost activity at higher concentrations. However, in RINm5F cells, the inhibitory effect of YPDPR was preserved. 3-iodo- YPDPR exhibited a similar inhibitory profile to enterostatin across a wide concentration. These studies demonstrate the functional importance of the N-terminal sequences of enterostatin in regulating insulin secretion but also suggest tolerance to some modifications. Radio-iodinated-YPDPR may be useful in characterising putative enterostatin receptors.

Background: This paper reports the prevalence of NIDDM and its associated risk factors in migrants of Indian ethnic background, who resided in Melbourne, Australia, and were recruited for an Indian Health Study from July 1993 to October 1995. The relationships between fasting plasma glucose and other NIDDM associated factors were investigated, and a comparison of the NIDDM prevalence of this population was made with that of Anglo-Celtic Melbournians. Methods: A representative group of 297 men and 255 women (aged 25-78 years) was recruited using a method of identification of characteristic surnames in the telephone directory. Participants were considered to be diabetic either if they had been diagnosed by a medical practitioner, regardless whether they were receiving medication for it, or if they had a fasting plasma glucose ³ 7.8 mmol/L. Results: The prevalence of NIDDM in the Indian Australians was 10.1% for men and 12.2% for women. No significant gender difference was observed in the study population (c2 test P = 0.44). The high prevalence of NIDDM of the study population is consistent with the findings of studies of South Asian migrants in other countries. Compared to the Anglo-Celtic population, the prevalence of NIDDM was higher for the Indians. It was also found that fasting plasma glucose was positively associated with age, body fat mass, abdominal circumference, abdomen-to-hip ratio, and fasting insulin, both in men and women. Conclusions: The Indian migrants in Melbourne, Australia, had a 11.1% prevalence of NIDDM, which was significantly higher than that of the Anglo-Celtic Australians. These findings are in agreement with other studies of South Asian migrants. It is proposed that the mechanism(s) underlying the pathophysiology of the metabolic disturbances in those of Indian ancestry may differ from other ethnic groups, and this may involve the abdominal fat distribution.

In this single case study we attempt to outline the possible effect of low level laser therapy on delayed wound healing (LLLT) in chronic dehiscent sternotomy of a diabetic individual. The methods that were employed to evaluate changes pre and post irradiation were wound photography, wound area measurement, pressure ulcer scale of healing (PUSH) and visual analogue scale (VAS) for pain. After irradiation, proliferation of healthy granulation tissue was observed with decrease in scores of PUSH for sternal dehiscence and VAS for bilateral shoulders and sternal dehiscence. We found that LLLT irradiation could be a novel method of treatment for chronic sternal dehiscence following coronary artery bypass grafting (CABG), as it augments wound healing with an early closure of the wound deficit.

Diabetic dyslipidemia is the product of oxidative stress-induced damage along with the simultaneous decline of antioxidant defense mechanisms leading to cellular damage, increased lipid peroxidation and subsequent development of severe complications in type 2 diabetes mellitus (DM). Antioxidant vitamin C has been reported to reduce oxidative stress by arresting free radical damage and thereby improves lipid levels in type 2 DM patients. The present study was aimed to [...]

Evaluation of safety and efficacy of insulin aspart (NovoRapid® FlexPen®), insulin detemir (Levemir® FlexPen®), biphasic insulin aspart 30 (NovoMix® 30 FlexPen®), and their combination for the treatment of type 1 and type 2 diabetes in the Gulf countries in a prospective, multicenter, open label, non-interventional, observational study. A total of 5,866 patients with type 1 or type 2 diabetes were followed for 6 months. The primary efficacy endpoint was the change in glycoslyated hemoglobin (HbA1c) from baseline, while the secondary efficacy endpoints were the percentage of patients achieving HbA1c less than 7.0% approximately 12 and 24 weeks compared to baseline and changes in fasting blood sugar and postprandial blood sugar after 12 and 24 weeks of treatment compared to baseline. The primary safety endpoint was the incidence of major hypoglycemic episodes during the 24 weeks of using the study medication, while the secondary safety endpoints were changes in the number of hypoglycemic episodes in the past 4 weeks prior to the routine visits at approximately 12 and 24 weeks of treatment. The reduction in glycemic control measured by mean HbA1c from baseline to after 6 months was 2.4 (from 9.8 to 7.4, p-value < 0.0001) in all treatment groups after 24 weeks irrespective of the previous insulin regimen. The change in HbA1c after 24 weeks of treatment was 2.4 % in the Levemir® group, -2.3% in the NovoMix®30 group, 2.5% in the NovoRapid® group, 2.3 % in the combination group. The proportion of patients who achieved the target HbA1c increased from 1.7% at baseline to 26.9% after 24 weeks of treatment with insulin analogues. The change in the mean body weight after 24 weeks of treatment was 1.3 kg in the Levemir® group, 0.9 kg in the NovoMix®30 group, 0.1kg in the NovoRapid® group, and 0.7kg in the combination group. The change in major hypoglycemia was as follows: In the detemir group 2.9% at baseline to 0.2% at week 24, in the BIAsp30 group was 2.9% at baseline to 0.2% at week 24, in the aspart group 3.1% at baseline to 0% at week 24 (p < 0.0001).Switching to insulin Aspart (NovoRapid® FlexPen®), insulin detemir (Levemir® FlexPen®), biphasic insulin aspart 30 (NovoMix® 30 FlexPen®), or the combination of any of them resulted in significant lowering in HbA1c, fasting blood sugar, postprandial blood sugar, postprandial glucose increment, and the number of major hypoglycemic attacks. The percentage of patients attaining the required HbA1c below 7% was 26.9%. The body weight was reduced in all treatment groups.

Diet and anthropometic measures are important indicators of risk of various complications in type 2 diabetics. The purpose was to assess the hypothesis that there would be gender differences in anthropometric measures and dietary intakes for energy and energy-yielding nutrients including oleic acid in the study population of well-controlled (HbA1c < 8 %) Caucasian type 2 diabetics. Males (n=18) and females (n = 14) participated. Subjects came in for two visits each 3 months apart. Males differed from females only in height (m) (1.72 + 0.02 vs 1.59 ± 0.01), hip circumference (cm) (103.0 ± 1.4 vs 117.8 ± 3.9), waist to hip ratio (0.99 ± 0.01 vs 0.87 ± 0.01 and waist to height ratio (0.591 ± 0.010 vs 0.640 ± 0.018). Despite a higher intake for total calories in males and similar intakes for the energy yielding nutrients including oleic acid in the study population of type 2 diabetics, males and females had similar weights and waist circumferences while males had greater waist to hip ratios, lesser waist to height ratios and very a strong trend toward lesser BMI. Females are further away from recommended anthropometric targets and as such appear to be at greater risk of complications from type 2 diabetes.

Type 2 diabetes mellitus (T2DM) is a major health problem in Guyana especially among women. This study evaluated the effects of lifestyle habits on blood glucose control and the development of complications in T2DM female patients. A pretested questionnaire was administered to a total of 39 women between the ages of 44 to 65 years who were previously diagnosed with T2DM for a period of no less than 5 years at the West Demerara Regional Hospital Diabetic Clinic. The patients were divided into two groups, those who adhered to healthy lifestyle habits (group 1) based on body mass index (BMI) and those who did not (group 2). Information for each group was based on lifestyle practices, fasting blood glucose (FBS), random blood glucose (RBS) and diabetic complications. The results show that the mean RBS and FBS values for patients who practised “healthy lifestyle habits” were significantly (p<0.05) lower when compared to those who practised “unhealthy lifestyle habits”. A significant majority of these patients also controlled their blood glucose with the use of one medication when compared to group 2 patients who had unhealthy lifestyle habits and who also needed two or more medications to treat their diabetes. Patients in group 1 who controlled their blood glucose levels and adhered to healthy life style habits had less diabetic complications. It was concluded that patients who adapted healthy lifestyle practices had lower mean RBS and FBS levels when compared to those who did not. These patients also had lower BMI and showed a reduced risk for the development of diabetic-induced long term complications. It can be concluded that a healthy diet and regular exercise are the mainstay therapy for patients with T2DM and to achieve this, the patients must adhere to life style changes to enjoy a better quality of life.

The prevalence of Type 2 Diabetes Mellitus (T2DM) in the United Arab Emirates (UAE) is steadily increasing, posing a major public health problem. This study assessed the value of specific clinical markers for T2DM among five generations of an extended Arab family. This family included 319 members of 41 nuclear families; from which 178 individuals (86 males, 92 females; 66 diabetic, 112 healthy) formed the study sample set. The ages of the participants ranged from 4 to 88 years. All participants completed a questionnaire that focused on baseline factors that have previously been associated with T2DM such as diet, smoking, and family history of the disease. The quantitative traits, fasting glucose, glycated hemoglobin (HbA1c), cholesterol, triglyceride, urea and creatinine levels were measured. Body mass index (BMI) and waist circumference were also recorded. The heritability of these eight quantitative traits were determined with values ranging from 6% to 48%. We found a significant relationship between T2DM diagnosis and waist circumference (p = 2.6, E-9) and BMI (p = 1.0, E-6). The estimated power for these two traits was 80% to 90%, respectively. Creatinine (p = 0.002) and cholesterol (p = 0.02) levels were also associated with T2DM. Our results support the link between environmental and genetic factors in the pathophysiology of T2DM and its related phenotypes in an Arab population.

Insulin resistance is an important pathogenic factor in type 2 diabetes patents. An easy and efficiency measurement predicting insulin resistance; which can be done easily by type 2 patients is desired. The aim of this study is to examine whether waist circumference is a better predictor of insulin resistance in type 2 diabetes than body mass index (BMI). From a population of 1356 registered diabetic patients, 144 who met (1) aged between 30 and 75 years, (2) being Chinese, (3) having had type 2 diabetes for more than one year, (4) having been taking gliclazide and metformin for more than 6 months were enrolled in this study. The main outcome evaluated is the associations of HOMA insulin resistance index (HOMA index); which were assessed using multiple linear regression analysis. The coefficients of multiple regression analysis with stepwise model showed that waist circumference ( = 0.35, p < 0.001) but not BMI ( = 0.01, p= 0.94), and hemoglobulin A1C% (HbA1C) ( = 0.25, p = 0.01) were the main predictors of HOMA index. These initial findings indicate that waist circumference is a better predictor of insulin resistance in type 2 diabetes than BMI.

The aim of the study was to compare the effects of pioglitazone and metformin on carbohydrate metabolism in diabetic and insulin resistant rats. Male albino rats were randomized into seven groups. The first, control group received high carbohydrate diet. The second, third and fourth groups were fed high fat diets for 6 weeks and either left untreated, or given pioglitazone (2.7 mg/kg/day) or metformin (180 mg/kg/day) in the last 3 weeks. The 5th, 6th, and 7th groups were made diabetic by single intraperitoneal injection of streptozotocin (STZ, 50 mg/kg) on day 15 of the 6-week high fat regimen. They were either left untreated, or given pioglitazone or metformin in the last 3 weeks. High fat diet induced insulin resistance evidenced by increased serum glucose, associated with increase in liver glucose-6-phosphatase and decrease in liver glucose-6-phosphate dehydrogenase and glucokinase activities. No significant difference was observed between rats treated with either pioglitazone or metformin. Both treatments showed significant increase in glucose-6-phosphate dehydrogenase activity by ~20 %, decrease in glucose-6-phosphatase activity by ~25 %, and decreases in liver and kidney glycogen. In diabetic rats, both pioglitazone and metformin decreased elevated serum glucose by ~30 %. Only metformin caused more than 2-fold increase in hepatic glycogen content, and normalized glucose-6-phosphatase activity. Only pioglitazone normalized elevated renal glycogen content and increased glucose-6-phosphate dehydrogenase activity. In conclusion pioglitazone and metformin had comparable effects on estimates of carbohydrate metabolism and insulin sensitivity in insulin resistant rats, but different effects in diabetic rats.

Porous polymers based on ruthenium and gold triphenylphosphine complexes (KPhos(Ru), KPhos(Ru)Bi, KPhos(AuCl) and KPhos(AuNTf2)) were prepared viaa cost-effective solvent knitting method with [RuHClCO(PPh3)3] or AuXPPh3(X = Cl, NTf2) as single monomers or combined with biphenyl, which represents a further approach to obtain heterogenized catalysts. The resulting materials mainly preserve the metal coordination environment of their parent complexes, are stable up to 350 °C and have reasonable surface areas (250–300 m2g−1for KPhos(Ru)-polymers). KPhos(Ru)s selectively catalyze the imination of alcohols in the presence of base and the results for KPhos(Au)s show they are effective for the intermolecular hydration and hydroamination of alkynes. These materials can be reused several times without significant loss of activity. This novel and simple method affords heterogenized catalysts that combine the reactivity and selectivity of their homogeneous counterparts with the stability and reusability of a heterogeneous framework.