Differential lipid profile and hormonal response in type 2 diabetes by exogenous insulin aspart versus the insulin secretagogue repaglinide, at the same glycemic control

Serum levels of proamylin and amylin in normal subjects and patients with impaired glucose regulation and type 2 diabetes mellitus

Amylin is the major constituent of pancreatic islet amyloid whose accumulation characterizes patients with type 2 diabetes mellitus (T2DM). Although amylin is tightly linked with T2DM, in many cases, proamylin may be the more toxic species. As the precursor of amylin, however, the pathophysiological role of proamylin remains unknown. In this study, we investigate whether serum levels of proamylin or amylin or the proamylin/amylin ratios are different among normal subjects and patients with impaired glucose regulation (IGR) and T2DM. Totally 79 subjects were divided into three groups according to the results of oral glucose tolerance test (OGTT); they were T2DM group (32 cases), IGR group (23cases), and normal glucose tolerance (NGT) group (24cases). Serum levels of amylin and proamylin were measured with an enzyme-linked immunosorbent assay (ELISA). The relationships between serum levels of proamylin, amylin, their ratios and anthropometric and metabolic parameters were also analyzed. The serum levels of proamylin were significantly higher in patients with IGR and T2DM than in control subjects. The serum levels of proamylin were significantly associated with IGR and T2DM, with the odds ratios of 1.589 (95%CI, 1.228-2.055, P < 0.01) and 1.860 (95%CI, 1.342-2.587, P < 0.01), respectively. Both fasting serum levels of proamylin and proamylin/amylin ratios were found to correlate negatively with HOMA-B and DeltaI30/DeltaG30. Serum levels of proamylin, amylin, and their ratios were positively correlated with HOMA-IR. BMI and HOMA-B were independent related factors with serum levels of proamylin. Our results suggest that proamylin may play an important role in amyloid deposit in patients with IGR and T2DM.

Gut microbiota in health and disease

Gut microbiota is an assortment of microorganisms inhabiting the length and width of the mammalian gastrointestinal tract. The composition of this microbial community is host specific, evolving throughout an individual's lifetime and susceptible to both exogenous and endogenous modifications. Recent renewed interest in the structure and function of this "organ" has illuminated its central position in health and disease. The microbiota is intimately involved in numerous aspects of normal host physiology, from nutritional status to behavior and stress response. Additionally, they can be a central or a contributing cause of many diseases, affecting both near and far organ systems. The overall balance in the composition of the gut microbial community, as well as the presence or absence of key species capable of effecting specific responses, is important in ensuring homeostasis or lack thereof at the intestinal mucosa and beyond. The mechanisms through which microbiota exerts its beneficial or detrimental influences remain largely undefined, but include elaboration of signaling molecules and recognition of bacterial epitopes by both intestinal epithelial and mucosal immune cells. The advances in modeling and analysis of gut microbiota will further our knowledge of their role in health and disease, allowing customization of existing and future therapeutic and prophylactic modalities.

Prevalence and correlates of inadequate glycaemic control: results from a nationwide survey in 6,671 adults with diabetes in Brazil

Diabetes is a significant public health burden on the basis of its increased incidence, morbidity, and mortality. This study aimed to estimate the prevalence of inadequate glycaemic control and its correlates in a large multicentre survey of Brazilian patients with diabetes. A cross-sectional study was conducted in a consecutive sample of patients aged 18 years or older with either type 1 or type 2 diabetes, attending health centres located in ten large cities in Brazil (response rate = 84%). Information about diabetes, current medications, complications, diet, and satisfaction with treatment were obtained by trained interviewers, using a standardized questionnaire. Glycated haemoglobin (HbA(1c)) was measured by high-performance liquid chromatography in a central laboratory. Patients with HbA(1c) > or = 7 were considered to have inadequate glycaemic control. Overall 6,701 patients were surveyed, 979 (15%) with type 1 and 5,692 (85%) with type 2 diabetes. The prevalence of inadequate glycaemic control was 76%. Poor glycaemic control was more common in patients with type 1 diabetes (90%) than in those with type 2 (73%), P < 0.001. Characteristics significantly associated with improved glycaemic control included: fewer years of diabetes duration, multi professional care, participation in a diabetes health education program, and satisfaction with current diabetes treatment. Despite increased awareness of the benefits of tight glycaemic control, we found that few diabetic patients in Brazil met recommended glycaemic control targets. This may contribute to increased rates of diabetic complications, which may impact health care costs. Our data support the public health message of implementation of early, aggressive management of diabetes.