Addition of Insulin to Treatment Regimen in Type 2 Diabetes: The Significance of Age and Duration among Sudanese Diabetic Patients

Background: Type 2 diabetes is a progressive disease and as the result of patient’s age and diabetes duration, β-cell ability for insulin secretion deteriorates continually and finally fails to meet body requirement. Intensification of treatment drug regimen including addition of insulin is critical to maintain glycemic target and reduce developing of long-term complications. Objective: The main purpose of this study was to investigate the effect of diabetes duration and patients’ age on addition of insulin to treatment regimen. Methods: A single centre, cross-sectional hospital-based study was done among 351 diabetes Mellitus (DM) patients visiting Ribat University Hospital Diabetic Clinic, Khartoum State, Sudan. Data was collected using constructed, validated and multiple-choice questionnaire. Results: From 351 patients enrolled in the study, female were 65.8% and male 34.2%. About 64.4% were on oral anti-diabetic;35.6% on insulin;about 31.6% shifted to insulin when their ages above 40 years;and 22.8% when diabetes duration was above 5 years. Co-morbidity was 54.4% and 60.2% of patients had hypertension. Conclusion: Interactions between age and longer duration of diabetes were mostly significant reasons for transferring patients to insulin. Percent of insulin users and co-morbidity was within international range.

Effect of insulin on hyperkalemia during anhepatic stage of liver transplantation

AIM:To investigate the effectiveness of insulin on decreasing serum potassium concentration during anhepatic stage of orthotopic liver transplantation. METHODS:Sixteen patients with serum potassium concentrations greater than 4.0 mmol/L at the onset of anhepatic stage were randomized into two groups.The patients in control group (n=8) received no treatment, while those in treatment group (n=8) received an intravenous bolus injection of regular insulin (20U) 10 min into the anhepatic stage,followed by a glucose infusion (500mL 50g/L dextrose) over 15 min. RESULTS:In control group,potassium concentration underwent no changes whereas in treatment group,it decreased from 4.8±0.48 mmol/L to 4.19±0.55 mmol/L (mean±SD) within 15 min and to 3.62±0.45 mmol/L 60 min after the therapy.The potassium concentration was lower in treatment group than in control group within 30 min of treatment (3.94±0.57 vs 4.47±0.42 mmol/L, respectively;P<0.05),and increased similarly 30 s after graft reperfusion in both groups of patients,but remained lower in treatment group (5.81±2.78 vs 7.44±1.75 mmol/L, respectively;P<0.05).The potassium concentration returned to pre-reperfusion levels within 5 min after graft reperfusion. CONCLUSION:In patients undergoing orthotopic liver transplantation,the administration of insulin rapidly decreases serum potassium concentration even in the absence of the liver,suggesting an important contribution by extrahepatic tissues in insulin-stimulated uptake of potassium.

Effect of Acupuncture on Plasmic Levels of Insulin,Glucagon and Hypercoagulability in NIDDM Complicated by Acute Cerebral Infarction

Twenty-one cases of acute cerebral infarction secondary to NIDDM were treated with acupuncture and conventional therapy, and compared with 16 cases treated with conventional therapy alone. The results showed that acupuncture was more effective in reducing insulin and glucagon levels (P

Insulin sensitivity and the diffuseness of coronary artery disease in humans

OBJECTIVE: To study the relationship between insulin sensitivity and diffuse coronary artery disease. METHODS: Ninety-two consecutive patients underwent coronary angiography were enrolled in the study. Relationships between the results of angiograms and both glucose tolerance and blood lipids were analyzed. RESULTS: The mean age of the 92 patients (70 males, 22 females) was 65.4 +/- 6.3 y. In the 78 patients diagnosed by angiography as coronary artery disease, diffuse lesion was more common in diabetic patients than in those without a diabetes history (12/13 vs 24/65, P = 0.00026). Fasting glucose [(6.06 +/- 2.43) x 10(-3) mol/L vs (4.80 +/- 1.47) x 10(-3) mol/L, P = 0.009], glucose levels at one hour [(12.37 +/- 4.38) x 10(-3) mol/L vs (9.10 +/- 3.97) x 10(-3) mol/L, P = 0.001], two hours [(11.12 +/- 5.64) x 10(-3) mol/L vs (7.49 +/- 4.29) x 10(-3) mol/L, P = 0.003] and three hours [(8.11 +/- 5.51) x 10(-3) mol/L vs (5.56 +/- 3.46) x 10(-3) mol/L, P = 0.020] after food were higher in patients with diffuse coronary disease than in those with non-diffuse coronary disease. Differences in the insulin sensitivity index (ISI) between the two groups was statistically significant (-4.36 +/- 0.52 vs -3.89 +/- 0.69, P = 0.003). The incidence of multiple-vessel disease in diabetic patients was higher than that in non-diabetic patients (12/13 vs 33/65, P = 0.00565). Glucose levels at two hours [(10.22 +/- 5.57) x 10(-3) mol/L vs (7.67 +/- 4.43) x 10(-3) mol/L, P = 0.034] and three hours [(7.90 +/- 5.47) x 10(-3) mol/L vs (5.22 +/- 2.79) x 10(-3) mol/L, P = 0.007] after food were higher in patients with multiple-vessel disease than in those with single-vessel disease. Impaired insulin sensitivity without a history of diabetes mellitus was commonly seen in patients with coronary artery disease. CONCLUSIONS: The diffuseness of coronary artery disease is associated with insulin sensitivity and blood glucose levels. Insulin resistance is a common phenomenon in non-diabetic patients.

Clinicopathologic features of surgically resected primary gastric lymphoma

AIM:To analyze the clinicopathologic characteristics of surgically resected gastric lymphoma patients. METHODS:We retrospectively analyzed 57 surgically resected gastric lymphoma patients,dividing them into 2 subgroups:Low grade MALToma (the LG group),High grade MALToma and Diffuse large B cell lymphoma (the HG group). RESULTS:The numbers of patients were:20 in the LG group, 37 in the HG group.The diagnostic rate of gastroscopy was 34.8% at primary diagnosis and 50% including differential diagnoses.The positive rates of Hpyloriwere similar between the 2 groups (68% vs77%).Multiple lesions were found in 19.3%.The proportion of mucosal and submucosal lesions was 80.0%(16/20) in the LG group,and 24.3%(9/37) in the HG group (P<0.001).Lymph node invasion rates were 10.5%(2/19) in the LG group and 44.1%(15/34) in the HG group (P=0.031).The numbers of recurred patients were none in the LG group,and 8 in the HG group.By univariant analysis,group (P=0.024) and TNM stage (stage Ⅰ,Ⅱ vs stages Ⅲ,Ⅳ,P=0.002) were found to be the significant risk factors.There was a tendency of higher recurrence rate in the subtotal gastrectomy group than in the total gastrectomy group (P=0.50). CONCLUSION:The HG groups had a more advanced stage and a higher recurrence rate than the LG group.Although there was no difference between subtotal and total gastrectomies,more careful assessments of multiplicities and radical resections with lymph node dissections seem to be needed because of multiplicity and LN invasion even in LG group.

衰老过程中胰岛β—细胞功能变化及体育活动的重要影响

年龄与胰岛素分泌机能之间的关系较复杂。大鼠随年龄增加每一个β-细胞分泌胰岛素的能力进行性降低,可以增加较多的β-细胞代偿。通常一致的是人随年龄增加葡萄糖耐量下降,在老年人中对葡萄糖耐受性差相当普遍,但增加β-细胞群的能力有限,年龄增加使非胰岛素依赖性糖尿病(NIDDM)流行。胰岛素耐受性及代偿性高胰岛素血症导致脂代谢、血压调节和纤维蛋溶解活性异常,这些都使冠心病(CHD)易感性增多。运动训练对胰岛素敏感性葡萄糖耐受性在衰老过程中具有良好作用,可以预防非胰岛素依赖性糖尿病和冠心病的发生。

Novel non-invasive biological predictive index for liver fibrosis in hepatitis C virus genotype 4 patients

AIMTo investigate the diagnostic ability of a non-invasive biological marker to predict liver fibrosis in hepatitis C genotype 4 patients with high accuracy. METHODSA cohort of 332 patients infected with hepatitis C genotype 4 was included in this cross-sectional study. Fasting plasma glucose, insulin, C-peptide, and angiotensin-converting enzyme serum levels were measured. Insulin resistance was mathematically calculated using the homeostasis model of insulin resistance (HOMA-IR). RESULTSFibrosis stages were distributed based on Metavir score as follows: F0 = 43, F1 = 136, F2 = 64, F3 = 45 and F4 = 44. Statistical analysis relied upon reclassification of fibrosis stages into mild fibrosis (F0-F) = 179, moderate fibrosis (F2) = 64, and advanced fibrosis (F3-F4) = 89. Univariate analysis indicated that age, log aspartate amino transaminase, log HOMA-IR and log platelet count were independent predictors of liver fibrosis stage (P CONCLUSIONOur predictive model is easily available and reproducible, and predicted liver fibrosis with acceptable accuracy.

Effect of surgical castration on risk factors for arteriosclerosis of patients with prostate cancer

OBJECTIVE: To analyze the effect of castration on risk factors for arteriosclerosis of patients with prostate cancer. METHODS: Thirty patients with primary regional prostate adenocarcinoma limited to the prostate theca were selected in this study. Serum levels of testosterone (T), free testosterone (FT), dehydroepiandrosterone (DHEA), sex hormone-binding globulin (SHBG), prostatic specific antigen (PSA), triglyceride (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), apoprotein alpha(1) (APOalpha(1)) and apoprotein beta (APObeta), insulin, plasma fibrinopeptide A (FPA), plasminogen activator inhibitor-1 (PAI-1) and fibrinogen were determined just prior to, 1 week and 1, 4 and 8 months after castration. RESULTS: T, FT and PSA decreased significantly 1 week after castration (21.12 +/- 15.11 ng/ml vs 383.9 +/- 62.6 ng/ml, P

Diagnostic criteria of latent autoimmune diabetes in adults(LADA):a review and reflection

Diabetes has become a major public health problem in China nowadays.There are almost 97 million diabetic patients nationwide.Latent autoimmune diabetes in adults(LADA)is a subtype of autoimmune diabetes.Although it has been reported for about 20 years,the diagnostic criteria of this disease remain controversial.The discussion mainly focused on serum autoantibodies,period of insulin need and age of diagnosis.Besides,β cell function,metabolic parameters,genetic factors and cell immunity may also contribute to the formulation of the criteria.Here,we aim to review and discuss the diagnostic criteria of latent autoimmune diabetes in adults.

Efficacy of Intragastric Balloons in the Markers of Metabolic Dysfunction-associated Fatty Liver Disease:Results from Meta-analyses

Background and Aims:Nonalcoholic fatty liver disease,now renamed metabolic dysfunction-associated fatty liver disease(MAFLD),is common in obese patients.Intragastric balloon(IGB),an obesity management tool with low complication risk,might be used in MAFLD treatment but there is still unexplained heterogeneity in results across studies.Methods:We conducted a systematic search of 152 citations published up to September 2020.Meta-analyses,stratified analyses,and meta-regression were performed to evaluate the efficacy of IGB on homeostasis model assessment of insulin resistance(HOMA-IR),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and gamma-glutamyl transpeptidase(GGT),and to identify patients most appropriate for IGB therapy.Results:Thirteen observational studies and one randomized controlled trial met the inclusion criteria(624 participants in total).In the overall estimate,IGB therapy significantly improved the serum markers change from baseline to follow-up[HOMA-IR:1.56,95%confidence interval(CI)=1.16–1.95;ALT:11.53 U/L,95%CI=7.10–15.96;AST:6.79 U/L,95%CI=1.69–11.90;GGT:10.54 U/L,95%CI=6.32–14.75].In the stratified analysis,there were trends among participants with advanced age having less change in HOMA-IR(1.07 vs.1.82).The improvement of insulin resistance and liver biochemistries with swallowable IGB therapy was no worse than that with endoscopic IGB.Multivariate meta-regression analyses showed that greater HOMA-IR loss was predicted by younger age(p=0.0107).Furthermore,effectiveness on ALT and GGT was predicted by basal ALT(p=0.0004)and GGT(p=0.0026),respectively.Conclusions:IGB is effective among the serum markers of MAFLD.Younger patients had a greater decrease of HOMA-IR after IGB therapy.