Effect of insulin on functional status of cord blood-derived dendritic cells and on dendritic cell-induced CTL cytotoxicity against pancreatic cancer cell lines

BACKGROUND: Dendritic cells (DCs) are the most important antigen-presenting cells in the human body, and DCs with different mature status possess different or even opposite functions. This study was designed to explore the influence of insulin on the functional status of cord blood-derived DCs and on DC-induced cytotoxic T lymphocyte (CTL) activity against pancreatic cancer cell lines. METHODS: Mononuclear cells were isolated from fresh cord blood. Interleukin-4 (IL-4) and granulocytemacrophage colony-stimulating factor (GM-CSF) were used to induce or stimulate the mononuclear cells. Insulin at different concentrations served to modify DCs, and then DC morphology, number, and growth status were assessed. The DC immunophenotype was detected with a flow cytometer. The IL-12 in DC supernatant was determined by ELISA. DC functional status was evaluated by the autologous mixed lymphocyte reaction. T lymphocytes were induced by insulin-modified DCs to become CTLs. The CTL cytotoxicity against pancreatic cancer cell lines was determined. RESULTS: Mononuclear cells from cord blood can be differentiated into DCs by cytokine induction and insulin modification. With the increase in insulin concentration (2.5-25 mg/L), the expression of DC HLA-DR, CD1 alpha, CD80, and CD83 was significantly increased, the DC ability to secrete IL-12 was significantly improved, DC function to activate autologous lymphocytes was significantly enhanced, and the cytotoxicity of CTLs induced by insulin-modified DCs against pancreatic cancer cell lines was significantly strengthened. CONCLUSIONS: Insulin may facilitate DC induction and maturation, and improve the reproductive activity of autologous lymphocytes. The cytotoxicity of CTLs induced by insulin-modified DCs against pancreatic cancer cell lines was significantly enhanced. Insulin may serve as a factor modifying DCs and inducing CTLs in vitro in insulin biotherapy.

Insulin action in muscle and adipose tissue in type 2 diabetes:The significance of blood flow

Under normal metabolic conditions insulin stimulates microvascular perfusion(capillary recruitment) of skeletal muscle and subcutaneous adipose tissue and thus increases blood flow mainly after meal ingestion or physical exercise.This helps the delivery of insulinitself but also that of substrates and of other signalling molecules to multiple tissues beds and facilitates glucose disposal and lipid kinetics.This effect is impaired in insulin resistance and type 2 diabetes early in the development of metabolic dysregulation and reflects early-onset endothelial dysfunction.Failure of insulin to increase muscle and adipose tissue blood flow results in decreased glucose handling.In fat depots,a blunted postprandial blood flow response will result in an insufficient suppression of lipolysis and an increased spill over of fatty acids in the circulation,leading to a more pronounced insulin resistant state in skeletal muscle.This defect in blood flow response is apparent even in the prediabetic state,implying that it is a facet of insulin resistance and exists long before overt hyperglycaemia develops.The following review intends to summarize the contribution of blood flow impairment to the development of the atherogenic dysglycemia and dyslipidaemia.

Relationship between Plasma Ghrelin Levels and Insulin Resistance and Blood Pressure in Octogenarians

The association between fasting plasma ghrelin levels and insulin resistance and blood pressure(BP) in octogenarians was investigated in this study.A total of 487 unrelated octogenarians(including 203 men and 284 women) were enrolled in this cross-sectional study at the Healthy Care Center of Shanghai East Hospital,Tongji University,China,from October 2008 to April 2009.Plasma ghrelin was determined by using the enzyme linked immunosorbent assay(ELISA).Insulin sensitivity was assessed using the homeostasis model of assessment-insulin resistance(HOMA-IR).The age of the participants ranged from 80 to 89 years(mean=83.9±4.8 years) with a body mass index(BMI) of 25.3±4.9 kg/m2.Plasma ghrelin level[w1]s were 20.94±5.34 μg/L,being 20.89±5.53 μg/L in men and 21.38±3.73 μg/L in women respectively.Plasma ghrelin was not associated with systolic(P=0.981) or diastolic(P=0.724) BP,waist circumference(P=0.278),fasting insulin(P=0.246),fasting blood glucose(FBG)(P=0.693) and HOMA-IR(P=0.232).In the control cohort,no significant differences in plasma ghrelin were found between genders(P=0.489),and among subjects with hypertension(BP>140/90 mmHg)(P=0.284) and type 2 diabetes(P=0.776).In conclusion,fasting plasma ghrelin levels are not directly correlated with insulin resistance and BP among octogenarians.

A Fuzzy Controller for Blood Glucose-Insulin System

Diabetes therapy is normally based on discrete insulin infusion that uses long-time interval measurements. Nevertheless, in this paper, a continuous drug infusion closed-loop control system was proposed to avoid the traditional discrete approaches by automating diabetes therapy. Based on a continuous insulin injection model, two controllers were designed to deal with this plant. The controllers designed in this paper are: proportional integral derivative (PID), and fuzzy logic controllers (FLC). Simulation results have illustrated that the fuzzy logic controller outperformed the PID controller. These results were based on serious disturbances to glucose, such as exercise, delay or noise in glucose sensor and nutrition mixed meal absorption at meal time.

Elevated White Blood Cell Count Is Associated with an Increased Risk of Insulin Resistance among Non-Diabetic Taxi-Motorbike Drivers Working in Cotonou, Benin

High white blood cell count (WBC) and insulin resistance (IR) are interrelated events that contribute to non-communicable diseases (NCDs), including type-2 diabetes (T2D). However, associations between IR and hematological parameters have never been explored in populations of Benin. The aims of this study were to determine the prevalence of IR and associated hematological parameters in taxi-motorbike drivers (TMDs) working in Cotonou. A total of 133 participants were analyzed in this cross-sectional study. Complete blood count, including WBC and platelet, as well as fasting plasma glucose and insulin, were performed by standard procedures. IR was assessed using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Factors associated with IR, their odds ratios (ORs) and 95% confidence intervals (CIs) were determined by logistic regression analysis. The mean age of the study participants was 39.3 years. The HOMA-IR cut-off (75th percentile) for IR was 5.9. The overall prevalence of IR was 24.1%. IR increased with the increase of exposure duration and WBC levels. Logistic regression analysis revealed that the risk of IR increased significantly with higher total WBC, with adjusted ORs (95% CI) for the second and third tertiles of 3.56 (1.10 - 11.58) and 4.01 (1.21 - 13.31), respectively. Similar patterns of associations were observed in an analysis restricted to non-drinkers, although these estimates lacked statistical significance. BMI > 24.2 kg/m2 was independently associated with an increased risk of IR (OR = 3.82, 95% CI: 1.33 - 11.03, P = 0.013). In conclusion, the prevalence of IR in TMDs was 24.1%. IR was significantly associated with elevated WBC count and BMI. WBC may serve as a biomarker to identify individuals at the greatest IR risk.

An overview on antidiabetic medicinal plants having insulin mimetic property

Diabetes mellitus is one of the common metabolic disorders acquiring around 2.8%of the world's population and is anticipated to cross 5.4%by the year 2025.Since long back herbal medicines have been the highly esteemed source of medicine therefore,they have become a growing part of modern,high-tech medicine.In view of the above aspects the present review provides profiles of plants(65 species) with hypoglycaemic properties,available through literature source from various database with proper categorization according to the parts used,mode of reduction in blood glucose(insulinomimetic or insulin secretagugues activity) and active phyloconsliluents having insulin mimetics activity.From the review it was suggested that,plant showing hypoglycemic potential mainly belongs to the family Leguminoseae,Lamiaceae,Liliaceae,Cucurbitaceae, Asteraceae,Moraceae,Rosaceae and Araliaceae.The most active plants are Allium sativum. Gymnema sylvestre,Citrullus colocynthis,Trigonella foenum greacum,Momordica charantia and Ficuts bengalensis.The review describes some new bioactive drugs and isolated compounds from plants such as roseoside,epigallocatechin gallate,beta-pyrazol-1-ylalanine,cinchonain Ib,leucocyandin 3-O-beta-d-galactosyl cellobioside,leucopelargonidin-3- O-alpha-L rhamuoside,glycyrrhetinic acid,dehydrotrametenolic acid,strictinin,isostrictinin,pedunculagin, epicatechin and christinin-A showing significant insulinomimetic and antidiabetic activity with more efficacy than conventional hypoglycaemic agents.Thus,from the review majorly,the antidiabetic activity of medicinal plants is attributed to the presence of polyphenols,flavonoida, terpenoids,coumarins and other constituents which show reduction in blood glucose levels.The review also discusses the management aspect of diabetes mellitus using these plants and their active principles.

Prior or Concomitant Drinking of Vegetable Juice with a Meal Attenuates Postprandial Blood Glucose Elevation in Healthy Young Adults

Controlling postprandial blood glucose levels can prevent and improve lifestyle-related diseases. We aimed to evaluate the effects of a commercially available vegetable juice, which is a convenient alternative to vegetables, on postprandial glucose elevation. In test 1, we confirmed the appropriate timing to consume the vegetable juice (200 mL), and demonstrated that postprandial glucose elevation was attenuated by drinking the vegetable juice with or before the experimental meal. The change in maximum concentration (ΔCmax) of blood glucose was the lowest when the vegetable juice was consumed at 30 min before the meal. In test 2, we confirmed the necessary ingestion volumes of vegetable juice (range: 68.5 - 274 mL) for attenuating the response to 50 g of carbohydrates. After drinking 200 mL of vegetable juice, the ΔCmax and incremental area under the curve values for blood glucose were significantly lower than those for after drinking the same volume of water (p < 0.05). However, a greater volume of vegetable juice did not provide an additive effect. Our results suggest that approximately 200 mL of vegetable juice at 30 min before meals is the most effective method for using vegetable juice to suppress postprandial blood glucose elevation. Stimulation of insulin secretion due to the pre-meal vegetable juice intake may contribute to this effect, although further studies are needed to identify the detailed mechanism for the attenuation.

High-Level Circulating Total Calcium and Low Phosphate as Predictors of Insulin Resistance among Non-Diabetic Taxi-Motorbike Drivers Living and Working in Cotonou, Benin

Insulin resistance (IR) is a well-recognized marker of increased cardiovascular diseases (CVDs) and type 2 diabetes (T2D) risk. Therefore, screening for IR predictors would help reduce the likelihood of progression from early stage of IR to T2D or CVDs. However, the knowledge of association between IR and circulating total calcium (CTCa) and phosphate levels among non-diabetic patients in Benin is lacking. We investigated whether CTCa and phosphate levels within the normal ranges are associated with IR risk among taxi-motorbike drivers (TMDs) living and working in Cotonou. We evaluated 134 non-diabetic TMDs (aged 22 - 59 years) based on CTCa, phosphate, glucose, fasting insulin, and IR levels. IR was assessed using the homeostatic model assessment-insulin resistance (HOMA-IR). IR was defined as the 75th percentile of HOMA-IR value. Cardiometabolic factors were analyzed by tertiles of CTCa and phosphate levels (low, middle, and high groups). Logistic regression models evaluated the relationships between IR and CTCa and phosphate levels. Our results showed that participants with high CTCa levels had the highest prevalence of IR, elevated total cholesterol and high-density lipoprotein cholesterol. In a fully adjusted model, the odd ratio (OR) of having IR comparing the highest (>2.50 mmol/L) to the lowest CTCa levels (1.23 mmol/L) and the lowest levels (<1.10 mmol/L) of phosphate was 0.28 (p = 0.037). In conclusion, our study demonstrates that elevated CTCa and low phosphate levels are significant predictors of IR in non-diabetic patients. Continuous monitoring of these markers may help identify earlier individuals at greatest IR risk.

A secretory function of human insulin-producing cells in vivo

BACKGROUND: Mesenchymal stem cells derived from human umbilical cord blood (UCB-MSCs) have good research and application prospects in the treatment of diabetes. We once induced UCB-MSCs to differentiate into insulin-producing cells (IPCs) in vitro, but we did not know the functions of these cells in vivo. The aim of this study was to assess the functional effects of IPCs on insulin secretion and their role in the treatment of diabetes in vivo. METHODS: UCB-MSCs were induced to IPCs by an inducing protocol with extracellular matrix gel. BALB/C nude mice were made hyperglycemic by intraperitoneal injection of streptozotocin. The diabetic mice were transplanted with 1x10(7) IPCs under the renal capsule or with phosphate-buffered saline as a control. After transplantation, the grafts were analyzed by immunocytochemistry for the expression of human insulin; the serum human insulin levels were measured; and blood glucose and body weight status were monitored. RESULTS: Immunofluorescence showed that numerous IPCs under the kidney capsule were insulin-positive. On day 14 after transplantation, the serum human insulin level of the treatment group (n=9) averaged 0.44 +/- 0.12 mU/L, which was higher than that of the control group (n=9) that did not express insulin (t=10.842, P<0.05). The diabetic mice remained hyperglycemic and kept losing body weight after IPC transplantation, and there was no significant difference in the control group. CONCLUSION: IPCs differentiated from UCB-MSCs generate human insulin in diabetic mice, but more research is needed to make further use of them to regulate hyperglycemia and body weight in vivo. (Hepatobiliary Pancreat Dis Int 2009; 8: 255-260)

Elevated alanine aminotransferase activity is not associated with dyslipidemias,but related to insulin resistance and higher disease grades in non-diabetic non-alcoholic fatty liver disease

Objective:To explore demographic and metabolic factors associated with increased alanine aminotransferase(ALT)activity in non-diabetic non-alcoholic fatty liver disease(NAFLD)patients.Methods:Overall 372 patients who consecutively attended to Gastroenterology Clinic of Baqiyatallah University of Medical Sciences,Tehran,Iran awere diagnosed as NAFLD entered into analysis.Exclusion criteria were having diabetes mellitus and fasting blood glucose over126 mg/dL,active hepatitis B virus infection,having hepatitis C virus positive serology,and to be under corticosteroid therapy.ALT levels were considered pathologically high when it was over30 IU/L for men and over 19 IU/L for women.Results:Bivariate analyses using t test and chisquare test showed that patients with pathologically augmented ALT levels had significantly higher NAFLD grades in their ultrasonographic evaluations(P=0.003).Moreover,these patients represented significantly higher homeostatic model assessment levels(P=0.003),levels of serum insulin(P=0.002),fasting blood glucose(P<0.001),and uric acid(P=0.02).The prevalence of insulin resistance was also higher in patients with increased serum ALT concentrations.Multifactorial logistic regression models showed that ultrasonographic grading of NAFLD(P=0.027)and insulin resistance(P=0.013)were the only variables significantly associated with abnormal ALT levels.Conclusions:This study shows that the associations of increased ALT serum levels in NAFLD patients are different from what are supposed before.By excluding diabetic patients from our population,we find that increased ALT levels are not associated with dyslipidemias but are independently associated with insulin resistance and NAFLD grading on ultrasonographic evaluations.Further studies are needed to confirm our results.

脾瘅方加减联合二甲双胍治疗肥胖型2型糖尿病的临床疗效及对其血脂、胰岛素抵抗指数的影响

目的分析脾瘅方加减联合二甲双胍治疗肥胖型2型糖尿病(Diabetes mellitus type 2,T2DM)患者的临床疗效及对其血脂、胰岛素抵抗指数(Homeostatic Model Assessment of Insulin Resistance,HOMA-IR)的影响。方法选取2022年1月—2023年2月期间就诊于济宁市中医院的肥胖型T2DM患者100例作为研究对象,按随机数表法分为对照组和观察组,每组各50例。对照组常规服用二甲双胍0.5 g/次,3次/d;观察组在对照组基础上加用脾瘅方对症加减治疗。治疗12周后观察比较两组患者临床疗效,治疗前后血糖指标[血糖(Fasting blood glucose,FBG)、餐后2 h血糖(2-hour postprandial blood glucose,2 h PBG)、糖化血红蛋(Glycosylated hemoglobinA1c,HbA1c)]、中医证候积分、血脂指标[总胆固醇(Total cholesterol,TC)、甘油三酯(Triglycerides,TG)、低密度脂蛋白(Low density lipoprotein,LDL-C)]、胰岛素指标[空腹胰岛素(Fasting insulin,FINS)、胰岛素抵抗指数(Homeostasis Model Assessment-Insulin Resistance,HOMA-IR)、胰岛β细胞功能指数(Homeostatic model assessment ofβ-cell function,HOMA-β)]及炎症因子[白介素-6(Interleukin-6,IL-6)、超敏C反应蛋白(Highsensitivity C-reactive protein,hs-CRP)]水平。结果治疗后观察组临床总有效率94.00%(47/50)明显高于对照组78.00%(39/50),差异有统计学意义(P<0.05)。治疗后两组患者血糖FBG、2 h PBG、HbAlc指标及中医证候积分均较治疗前降低,差异有统计学意义(P<0.05);且观察组血糖FBG、2 h PBG、HbAlc指标及中医证候积分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血脂指标TG、TC、LDL-C均较治疗前降低,差异有统计学意义(P<0.05);且观察组血脂指标TG、TC、LDL-C均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者胰岛素FINS、HOMA-IR指标均较治疗前降低,HOMA-β指标均较治疗前升高,差异有统计学意义(P<0.05);且观察组胰岛素FINS、HOMA-IR指标明显低于对照组,HOMA-β指标明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者炎症因子IL-6、hs-CRP水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组炎症因子IL-6、hs-CRP水平均明显低于对照组,差异有统计学意义(P<0.05)。结论脾瘅方加减联合二甲双胍治疗肥胖型T2DM患者能有效调节血糖、血脂水平,改善胰岛素抵抗,减轻炎症反应,临床疗效显著。

Effect of acute oral chlorogenic acid ingestion on the inhibition of blood glucose excursions following glucose to-lerance testing

The aim of this study was to examine the inhibitory effect of acute oral chlorogenic acid (CGA) ingestion on increases in blood glucose levels following glucose tolerance testing. Ten healthy male adults (age: 25.9 ± 5.4 years) participated in the study. Blood samples were collected from the antecubital vein of subjects following overnight fasting. After a 120-min rest, they were administered 75 g glucose and chlorogenic acid or placebo. The amount of chlorogenic acid administered (in the form of capsules) to the subjects was 0.1g per body mass. In addition, only capsules were ingested in placebo ingestion conditions. Blood samples were collected 4 times during the 120-min rest period at intervals of 30 min. Serum insulin and plasma glucose levels were analyzed. Serum insulin levels increased significantly at 30 min after glucose ingestion, and fixed until 120 min in both conditions. Plasma glucose level increased significantly at 30 min after glucose ingestion, followed by a slow decrease. In addition, no significant difference was found between the conditions in each parameter. In conclusion, acute oral chlorogenic acid ingestion may not inhibition blood glucose increase following glucose tolerance.

胰岛素不同注射方式对糖尿病血糖控制效果的影响研究

目的分析胰岛素不同注射方式对2型糖尿病患者血糖控制情况的影响。方法选取2021年9月—2023年9月安溪县医院收治的186例2型糖尿病患者为研究对象,利用最新统计学软件生成随机序列后将其分为对照组、观察组,各93例。两组研究对象均选用门冬胰岛素治疗,其中对照组注射方式为多次胰岛素皮下注射,观察组注射方式为胰岛素泵持续泵注。对比两组血糖控制情况、胰岛素使用剂量、血糖达标情况以及胰岛β细胞功能。结果观察组空腹血糖、餐后2 h血糖及糖化血红蛋白水平均低于对照组,差异有统计学意义(P均<0.05)。观察组平均每天胰岛素使用量低于对照组,血糖达标时间短于对照组,且在达标即刻使用的胰岛素总量少于对照组,差异有统计学意义(P均<0.05)。观察组胰岛β细胞功能优于对照组,差异有统计学意义(P<0.05)。结论对于2型糖尿病患者,采用胰岛素泵持续泵注这一注射方式,有利于改善血糖、血压及血脂水平,同时改善胰岛β细胞功能,且使用胰岛素剂量更低,能够更快速地达到控糖标准。

CORRELATIONS BETWEEN BLOOD PRESSURE AND BODY WEIGHT, SERUM LEPTIN IN HIGH CALORIE DIET-INDUCED OBESE RATS

Objective To examine the change of body weight (BW) and blood pressure (BP) in obese rats, clarify relationships between BP and BW and other factors. Methods Male Spraque-Dawley rats were fed either with normal diet (ND) or high calorie diet (HC) for 20 weeks. BW and BP of tail artery were observed biweekly and tetraweekly respectively; serum leptin and fasting insulin (FINS) were detected by enzyme-linked immunoadsordent assay (ELISA) and radioimmunoassay (RIA) respectively. Fasting plasma glucose (FPG) and free fatty acid(FFA) were measured by conventional means. Results BW, abdominal fat weight (AFW), ratio of abdominal fat weight to body weight (R_ F/W), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum levels of leptin and FINS, FPG, FFA increased in the HD group after 20 weeks diet intervention (P<0.05 or P<0.01). SBP was strongly correlated with BW, leptin, FINS and FFA (P<0.05), DBP was correlated with FFA (r=0.47, P<0.05). In addition, leptin was positively correlated with BW, AFW, R_ F/W, FINS and FFA (P<0.05 or P<0.01). Conclusion In this study of high calorie-diet induced rats, the gain of BW is accompanied by increased BP. The obese rats have hyperleptinemia, hyperinsulinemia, hyperglycemia and dyslipidemia which may have important effects on the development of obesity-related hypertension. R_ F/W is the key factor in which affect serum leptin level.

电针对2型糖尿病大鼠骨骼肌GLUT4表达影响的研究

[目的]观察电针对2型糖尿病大鼠骨骼肌葡萄糖转运蛋白4(glucose transporter 4,GLUT4)表达的影响,探讨电针调节血糖的机制。[方法]将24只2型糖尿病大鼠随机分为空白对照组、运动干预组及电针组,每组8只,运动干预组大鼠给予2周跑台运动干预;空白对照组大鼠不给予任何干预;电针组大鼠开始将电针置于大鼠双侧足三里穴,进行连续波穴位刺激2周。分别检测各组大鼠治疗前后空腹血糖水平、胰岛素抵抗指数及治疗后大鼠骨骼肌细胞GLUT4水平。[结果]与干预前比较,运动干预组和电针组空腹血糖水平显著下降(P<0.001,P=0.028),胰岛素抵抗指数显著下降(P<0.001,P<0.001)。干预后组间比较,三组大鼠空腹血糖水平及胰岛素抵抗指数差异均有统计学意义(P<0.001),GLUT4表达水平差异有统计学意义(P<0.001)。[结论]电针刺激能改善2型糖尿病大鼠的胰岛素敏感性,并降低其血糖水平,其中调节骨骼肌细胞GLUT4水平可能是其调节血糖的一个重要机制。

奥利司他对多囊卵巢综合征伴胰岛素抵抗患者的疗效及安全性

目的 探讨奥利司他对多囊卵巢综合征(PCOS)伴胰岛素抵抗(IR)患者的治疗效果及安全性。方法 依据稳态模型法评估的胰岛素抵抗指数(HOMA-IR)选取2020年8月至2023年8月泰州市中医院收治的104例PCOS-IR患者,按随机数字表法分为对照组52例(失访2例)和试验组52例(失访5例)。对照组患者给予炔雌醇环丙孕酮,试验组患者给予奥利司他,两组均治疗3个月。对比两组患者机体测量学指标、糖脂代谢水平、激素水平及产生的不良反应。结果 治疗后,试验组患者BMI、体质量、腰围[分别为(25.74±1.08) kg·m^(-2)、(59.23±2.80) kg、(94.10±5.13) cm]均低于对照组[分别为(26.23±1.26) kg·m^(-2)、(60.51±2.31) kg、(96.5±5.20) cm](t=2.050、2.462、2.287,均P<0.05),总胆固醇(TC)、甘油三酯(TG)、空腹血糖(FPG)、HOMA-IR[分别为(3.86±0.73) mmol·L^(-1)、(1.68±0.72) mmol·L^(-1)、(3.75±0.88) mmol·L^(-1)、(1.61±0.37)]均低于对照组[分别为(5.12±0.13) mmol·L^(-1)、(1.98±0.43) mmol·L^(-1)、(4.78±0.35) mmol·L^(-1)、(2.78±0.43)](t=12.007、2.508、7.659、14.323,均P<0.05);两组患者治疗后卵泡雌激素(FSH)差异无统计学意义[(6.71±0.69) mIU·mL^(-1) vs(6.79±0.72) mIU·mL^(-1),t=0.558,P>0.05)],试验组总睾酮(T)、血清黄体生成素(LH)、LH/FSH[(1.38±0.22) nmol·L^(-1)、(6.24±0.78) IU·L^(-1)、(0.93±0.15)]均低于对照组[(1.84±0.27) nmol·L^(-1)、(7.12±0.83) IU·L^(-1)、(1.05±0.17)](t=9.165、5.373、3.677,均P<0.05);两组不良反应发生率差异无统计学意义(8.50%vs 10.00%,χ^(2)=0.064,P>0.05)。结论 奥利司他治疗PCOS-IR患者能有效减重,调节糖脂代谢及性激素水平,改善胰岛素抵抗,且安全性良好。

Subjective Lowering of Preprandial Blood Glucose and Cancer Prevention by Planning and Recognizing Initial Hunger

We recently described the training of the passage from scheduled to demanded meals in infants and adults. Subjects reduced energy intake by subjectively abolishing conditioned meals and by allowing intake only after demand by the infant or after hunger perception by the adult (Initial Hunger Meal Pattern;IHMP). Conditioned meals were those scheduled and/or presented to the infant as well to the adult by sight, smell, mentioning, gesturing or simply at a fixed mealtime. During IHMP instead, meals were suspended until the first infant’s demand or until an adult’s self-noticing arousal of hunger. IHMP was checked by measuring blood glucose before three meals per day (MBG) and was associated with significant decreases in diary-reported energy-intake, MBG, glycated hemoglobin, body weight, insulin AUC in glucose tolerance tests and in days with diarrhea as compared to randomized control subjects who maintained conditioned meals. Although generalized, conditioned eating is a modern aberration that is associated with development of insulin resistance and overall inflammation. These associations are well demonstrated independently from the implicated mechanism. A state of Overall Subclinical Inflammation greatly increases cell and DNA replications and replication errors. After decades of DNA errors, oncogenic cells arise and cumulate. A prevention of malignancies is possible by interrupting the development of conditioned eating, insulin resistance and associated overall inflammation.

Insulin Sensitivity and Gynaecological Features of Infertile Cameroonian Females with Polycystic Ovary Syndrome: A Cross-Sectional Study

Background: Polycystic ovary syndrome (PCOS), characterized by ovulatory dysfunction, polycystic ovary(PCO),hyperandrogenism and insulin resistance is the commonest endocrine disorder in women of reproductive age. It is an intriguing pathology that involves the perpetuation of a vicious circle with reproductive, endocrine and metabolic components. We aimed to assess the reproductive features and insulin sensitivity (IS) in infertile women with or without PCOS. Materials and Methods: We carried out a cross-sectional analytic study at the outpatient Obstetrics and Gynaecology Department of the Yaounde Gyneco-obstetric and Pediatrics Hospital, Cameroon from September 1st 2012 to March 31st 2013 giving total study duration of 07 months. Laboratory analyses were carried out at the National Obesity Centre(NOC)of the Yaounde Central Hospital, Cameroon. Results: Overall, 36 infertile females were enrolled, which included 15 diagnosed cases of PCOS according to Rotterdam consensus meeting of 2003 and 21 non PCOS subjects as control. PCOS women were younger than non PCOS women (28.8 ± 5.5 vs. 35.0 ± 4.2 years;p = 0.0004). The majority of the women in the PCOS group were spaniomenorrheic (11/15), and ultrasonographic findings were typical of PCOS. Hirsutism score was higher in the PCOS group with a median of 9 (7 - 13). Insulin sensitivity was impaired in two-thirds of the study population, with 12 women found to be insulin resistant(6 PCOS, 6 non PCOS), 12 patients had intermediate insulin sensitivity(2 PCOS, 10 non PCOS)and 12 insulin sensitive(7 PCOS, 5 non PCOS). Apart from blood glucose levels (p = 0.007), all other anthropometric and biological parameters were not significant. Spearman’s correlation identified fasting plasma glucose and total cholesterol as factors associated with insulin sensitivity in females with PCOS. Impaired fasting glucose was observed in 13 patients with 08 from the PCOS group. Conclusion: We conclude that young age, spaniomenorrhea and hirsutism are common findings in PCOS. Furthermore, our findings suggest that PCOS may be more of systemic metabolic disease than solely a purely gynecologic disorder as described hitherto. Despite normal fasting plasma glucose levels, a good proportion of these women has impaired insulin sensitivity and it is associated with a metabolic syndrome.

利拉鲁肽治疗冠心病合并2型糖尿病患者的临床研究

目的 分析利拉鲁肽治疗冠心病合并2型糖尿病患者的临床效果。方法 102例冠心病合并2型糖尿病患者,应用电脑随机选择方式将患者分为对照组和观察组,每组51例。对照组给予二甲双胍治疗,观察组给予二甲双胍结合利拉鲁肽治疗。对比两组心功能指标(左室射血分数、左室舒张末内径、心排血量以及QT离散度)、血糖指标[空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)]、胰岛素抵抗情况[胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)]。结果 治疗后,观察组左室射血分数(56.10±9.06)%、左室舒张末内径(45.80±6.64)mm、心排血量(5.60±1.18)L/min、QT离散度(45.03±6.31)ms优于对照组的(50.50±7.90)%、(50.20±7.07)mm、(4.88±1.01)L/min、(53.77±8.50)ms(P<0.05)。治疗后,观察组2 h PG(7.28±1.30)mmol/L、FPG(6.06±0.27)mmol/L、HbA1c(5.88±0.32)%优于对照组的(8.71±1.20)mmol/L、(7.01±0.76)mmol/L、(6.65±0.52)%(P<0.05)。治疗后,观察组HOMA-β、HOMA-IR优于对照组(P<0.05)。结论 结合冠心病合并2型糖尿病患者实际情况应用二甲双胍结合利拉鲁肽治疗,能够有效改善患者的心功能指标、血糖指标及胰岛素抵抗情况,具有优良的应用前景,在今后的工作过程中能够进一步应用。

Recovery of Hunger Sensations Associated with Low Preprandial Blood Glucose: An Easy Exit from Diabetes?

Background: Obesity, diabetes, asthma, autism, birth defects, dyslexia, attention deficit-hyperactivity disorder and schizophrenia have increased in children in the last half century. These increases may depend on the widespread, well known error in energy balance: the unremitting addition of fat at any will (decision) to eat. In most (60%) but not all people, the decision arises as conditioned before energy exhaustion of the energy available from previous meals. After meal suspension for few hours (up to 48 hours), healthy subjects identified the arousal of sensations of hunger that we named Initial Hunger (IH). After this identification, subjects distinguished IH from conditioned sensations before subsequent meals by mental comparison of the current arousal with the remembered IH. BG decreased to 76.6 ± 3.7 mg/dL and hunger sensations (Initial hunger, IH) arose spontaneously and corresponded to the complete exhaustion of the previous meals. Objective: Not Insulin Dependent (NID) diabetic people differ from fattening people in this: after meal suspension, they do not develop any hunger sensation nor the associated low blood glucose (BG). Methods: Meal suspension lets IH arise and after no arousal, reduction of energy intake. The two subjects consumed meals that provided at least 20 grams of animal protein and up to one kg of not-starchy vegetable (NSV) for 6 to 12 months. At reappearance of IH, we implemented an Initial Hunger Meal Pattern (IHMP). Results: We tried to implement IHMP training in two obese (BMI of 39 and 33) adults out of two consecutive recruitments of subjects who showed high fasting BG. We found an absence of BG decline to 76.6 ± 3.7 mg/dL and an absence of any hunger sensation after eating suspension. Both subjects lost 13% - 20% of their body weight and recovered 76.6 ± 3.7 mg/dL of BG and hunger sensations, i.e., went off diabetes. IHMP maintained the decreased body weight in the subsequent months. Conclusion: Diabetes develops for inveterate conditioned intake (when previous energy intake has not been fully exhausted before meals), excessive fattening (with presumed excessive post-absorption emission of fatty acids from fatty tissues), permanent loss of BG decline to 76.6 ± 3.7 mg/dL and permanent loss of physiological signals of hunger. A healthy, non-diabetic life may be recovered by painless loss of weight up to 20%. The body weight remained stable by implementing IHMP at reappearance of hunger sensations. This costs accurate energy intake planning instead of hunger endurance.