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Results for “Glycemic variability”

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PubMed2026

Long-term glycemic variability and risk of peripheral artery disease: a systematic review and meta-analysis of cohort studies.

BACKGROUND: A systematic review and meta-analysis to evaluate the impact of long-term glucose variability (GV) on the risk of developing peripheral artery disease (PAD). METHODS: The protocol was prospectively registered in PROSPERO (ID: CRD420251148763). Relevant longitudinal studies were identified through comprehensive searches of PubMed, Embase, and Web of Science. The primary outcome was the risk ratio (RR) of PAD comparing participants with high versus low GV. Summary effect sizes were calculated using a random-effects model to account for between-study heterogeneity. RESULTS: Eleven cohorts were included. Higher GV showed a positive association with PAD risk (RR: 1.42; 95% CI [1.21-1.66] p < 0.001), although substantial heterogeneity was present (I 2 = 91%). This association was consistent across subgroups defined by region (Asian vs. Western), study design, diabetic status, GV metrics, PAD diagnostic methods, and adjustment for HbA1c (all p for subgroup differences > 0.05), except for follow-up duration. Studies with follow-up < 8 years showed a stronger association than those with ≥ 8 years (RR: 1.64 vs. 1.19; p for subgroup difference = 0.006). CONCLUSIONS: Elevated long-term GV appears to be associated with an increased risk of PAD. However, substantial heterogeneity across studies suggests that the magnitude of this association should be interpreted with caution.

Humans↗

PubMed2026

Effects of continuous isomaltulose-containing gummy intake on interstitial glucose and salivary hormones during an 18-hole golf round: a randomized, double-blind controlled pilot study.

BACKGROUND: Golf is a prolonged, moderate-intensity sport requiring sustained physiological stability to manage cumulative stress and maintain performance. Although carbohydrate intake is commonly used to reduce fatigue, rapidly absorbed sugar-induced rapid blood glucose fluctuations may induce volatile arousal and latent metabolic stress. Isomaltulose, a slow-digesting disaccharide, provides a steadier glucose supply compared with sucrose. This exploratory pilot study examined the effects of isomaltulose intake on physiological stress markers, glycemic dynamics, and subjective responses during a competitive 18-hole golf round. METHODS: Twenty-three male collegiate golfers were randomized to either the isomaltulose group (ISO; n = 12) or the sucrose group (CON; n = 11) in a double-blind controlled trial. Participants consumed gummies containing isomaltulose or sucrose immediately after each hole (12.1 g carbohydrate per hole; total carbohydrate intake: 217.5 g). Primary outcomes were salivary stress markers [cortisol, testosterone, and dehydroepiandrosterone sulfate (DHEAS)] levels. Secondary outcomes included interstitial glucose concentration measured via continuous glucose monitoring, subjective assessments (i.e. sleepiness, relaxation, and concentration), and golf performance (18-hole score). Between-group comparisons at each time point were conducted using planned Welch's t-tests. RESULTS: No significant between-group differences were observed for 18-hole score (p = 0.38) or mean interstitial glucose concentration (p = 0.20). However, exploratory analyses revealed distinct hormonal variations; salivary DHEAS and testosterone levels were higher in the ISO group during the latter half of the round (p < 0.05), whereas both declined in the CON group. Regarding glycemic variability, the ISO group demonstrated a more stable glucose profile with a medium effect size for lower standard deviation (ISO: 14.7 ± 1.9 vs. CON: 16.7 ± 4.6 mg/dL; d = 0.58), although this difference was not significant. Conversely, subjective outcomes diverged; the CON group reported significantly greater subjective arousal (wakefulness and relaxation) (p < 0.01) relative to the ISO group. CONCLUSIONS: In conclusion, continuous intake of isomaltulose-containing gummies during an 18-hole golf round was associated with differences in selected physiological markers, including DHEAS and testosterone concentrations. However, these findings were not accompanied by improvements in objective golf performance outcomes compared with sucrose-containing gummies. Isomaltulose may influence glycemic dynamics and hormonal responses during prolonged golf play; however, the practical significance of these effects remains exploratory. Further studies with larger sample sizes and appropriate repeated-measures frameworks are needed to determine whether such physiological changes translate into meaningful performance or recovery benefits.

Humans↗

PubMedDate not supplied

[Evaluation of diabetic glycemic control in hospital and extra-hospital regimen (author's transl)].

It is suggested an evaluation of the degree of diabetic control in insulin-dependent "difficult" patient, during the period following the discharge from hospital. In 13 cases, the quality of glycemic regulation was compared in intra- and extra-hospital therapeutic regimen by means of 3 new indices of the diurnal blood sugar profile: the Mbs, delta, and Mdelta values. Mbs value describescribes the mean level of the blood sugar curve; delta indicates the amplitidue of the glycemic variability field; Mdelta reports both maximal and minimal extremes of the curve. A combination of the first two parameters proved adequate for a clinical assessment of diabetic control. In the majority of the cases, blood glucose patterns were found similar or even improve in extra-hospital conditions. The insulin dosage ordered during hospital staying was confirmed in all, but one, patients. Psychological approach is probably essential for such good results. The procedure seems to be suitable in order to establish a more correct starting point for an effective treatment of the diabetic out-patient.

Adolescent↗

PubMed1978

[Evaluation of diabetes control by new numerical indices of daily blood glucose values].

Attempts to assess the degree of diabetic control by numerical expressions of blood glucose behaviour have been performed by Schlichtkrull et Al. (M-Ms value) and by Molnar, Service et Al. (MAGE, MODD, MBG and FBG values). However these methods, partly derived from the results of continuous blood monitoring, fail to give qualitative information about the glycemic daily profile. In order to obtain a more complete estimation of the diurnal blood sugar curve, a simple set of three indices is introduced by our group: 1) the Mbs value (modified); 2) the mean difference (delta value) of the various Mbs/bs calculated with a HP 25 Hewlett-Packard, and 3) the mean of the differences, exceeding delta, which are between contiguous Mbs/bs (M delta value). This investigation was carried out in 103 diabetic observations, on the basis of eight blood-sugar daily determinations (Destrostix Reflectance Meter) on two successive twenty-four-hour periods, under standard conditions of diet, exercise and therapeutic regimen. As the results show, modified Mbs describes the mean level of the glycemic profile; delta indicates the amplitude of the glycemic variability field; M delta reports both maximal and minimal extremes of the curve. A correlation of these parameters is expressed by a formula, which might distinguish stable from unstabel ("brittle") diabetes and allow clinical comparison in different treatment conditions.

Aged↗

PubMed1992

Alterations in glucose metabolism during menstrual cycle in women with IDDM.

OBJECTIVE: To examine the hormonal mechanisms underlying the variability in glycemic control during the different phases of the menstrual cycle in women with insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS: Hyperglycemic (11.7 +/- 0.1 mM), hyperinsulinemic (24 +/- 3 mU/L) clamp studies were performed in 16 women with IDDM during the follicular (day 8 +/- 1) and luteal (day 23 +/- 1) phases of the menstrual cycle. Seven of the patients (group 1) experienced worsening glucose control during the luteal phase, whereas nine patients (group 2) did not. RESULTS: In group 1, glucose metabolism fell from 30.2 +/- 3.8 mumol.kg-1.min-1 during the follicular phase to 24.5 +/- 2.0 mumol.kg-1.min-1 during the luteal phase (P = 0.09), whereas in group 2 it increased from 18.5 +/- 1.2 to 23.2 +/- 2.3 mumol.kg-1.min-1 (P = 0.03). The decrease in glucose metabolism during the luteal phase in patients in group 1 was associated with a significant rise in the serum estradiol levels from the follicular to luteal phase (164 +/- 39 vs. 352 +/- 59 pM, P = 0.006), whereas this rise was not observed in group 2 (334 +/- 156 vs. 423 +/- 74 pM, NS). Changes in other reproductive hormones (progesterone, testosterone, dihydrotestosterone, androstenedione, luteinizing hormone, follicular-stimulating hormone, or prolactin) were not related to the differences in glucose uptake in the two groups. CONCLUSIONS: 1) Marked heterogeneity in glucose metabolism is seen throughout the menstrual cycle in women with IDDM, 2) a subgroup of patients exhibits worsening premenstrual hyperglycemia and a decline in insulin sensitivity during the luteal phase, and 3) the deterioration in glucose uptake in this subgroup was associated with a greater increment in estradiol levels from the follicular to the luteal phase.

Adult↗

PubMed1992

Macular recovery time, diabetic retinopathy, and clinical variables after 7 years of improved glycemic control.

Effects of long-term improved glucose control on neurosensory retinal function are investigated. Changes in macular recovery of nyctometry (photostress) are assessed in 45 insulin-dependent diabetic patients between study start and after 7 years prospective follow-up (the Oslo Study). Intensified insulin treatment improved glycosylated hemoglobin (HbA1) from 11.7 +/- 2.2% at start to a 7-year cumulative mean of 9.5 +/- 1.5% (p less than 0.0001). Improved macular recovery performance was observed in patients with 7-year mean HbA1 below 10%, compared to a worsening in those above 10% (p less than 0.001-0.02), and non-proliferative retinopathy progressed less in those with HbA1 below 10%, than in those above (p less than 0.01). Macular recovery at study start did not predict progression or outcome of retinopathy 7 years later. Intraocular pressure fell during the 7 years (p less than 0.001) and was cross-sectionally negatively correlated to macular recovery at the 7-year end-point (p less than 0.001-0.002). Macular recovery was not related to age, duration of diabetes, systemic blood pressure, or urinary albumin excretion level. The study indicates that severity of retinopathy, glycemic control and intraocular pressure are interesting covariants to neurosensory dysfunction in diabetes. Furthermore, the study suggests a critical level of long-term blood glucose or retinopathy, or both, above which neurosensory function of macular recovery is significantly reduced.

Adult↗

PubMed1992

Oscillatory potentials, retinopathy, and long-term glucose control in insulin-dependent diabetes.

The main objective of the study was to assess effects of long-term lowering of glucosylated hemoglobin (HbA1%) on neurosensory function in insulin-dependent diabetes. Individual (OP-1, OP-2, OP-3) and summed (OP-sum) amplitudes of oscillatory potentials (OPs) of electroretinography were recorded at study start and 7-years later in 45 patients (the Oslo study). As an overall 7-year change, amplitudes of OP-2, OP-3 and OP-sum were reduced (p < 0.0001-0.01), retinopathy worsened (p = 0.005), intraocular pressure decreased (p < 0.001), systolic blood pressure increased (p < 0.0002), and glycemic control improved from HbA1 of 11.2 +/- 2.2% at study start to a 7-year cumulative mean of 9.5 +/- 1.5% (p < 0.0001). Multiple regression analysis did not identify any independent relations between change in OP-1, OP-2, OP-3, OP-sum and change in glycemic control or background variables, including change in age and duration of diabetes. However, cross-sectional observations at 7 years showed negative correlations between all OPs and age (p < 0.0001-0.003), and between OP-3 and duration (p = 0.003) and counts of microaneurysms (p = 0.02). The data suggest that various clinical background variables may influence individual and summed amplitudes of OPs differently. Reduced neurosensory retinal function (OPs) seemed to appear after 7-years, independently of vascular defects of retinopathy and long-term improvement in glucose control.

Adolescent↗

PubMed1977

Brittle diabetes in pregnancy.

In eight brittle diabetics the insulin requirement increased during successful pregnancies from 35 to 64 U./day (in 29 stable severe diabetics from 53 to 78 U./day). The within-day glycemic excursions were calculated as the mean of the three differences between four time points: fasting, one hour after breakfast, two hours after breakfast, and two hours after lunch. This parameter was constant throughout the pregnancy in nondiabetics (34-46 mg./100 ml.) and stable severe diabetics (55-72 mg./100 ml.). In brittle diabetics it dropped from 147 mg./100 ml. before the pregnancy and 153 mg./ 100 ml. at eight weeks to 85 mg./100 ml. at 36 weeks. The between-day variability was calculated as the mean glycemic difference between two successive days at the four points of time noted above. It was very low in nondiabetics (49-53 mg./100 ml.). In brittle diabetics it decreased from 127 mg./100 ml. before pregnancy and 120 mg./100 ml. at eight weeks to 46-55 mg./100 ml. at 24-36 weeks. This shows that brittleness substantially decreased in the second half of pregnancy.

Adult↗

PubMed1992

Dynamics of glycemic normalization following transplantation of incremental islet masses in streptozotocin-diabetic rats.

We examined the dynamics of glycemic normalization following intraportal infusion of an incremental number of islets of Langerhans in male Wistar-Furth rats. Non-fasted plasma glucose, 24-hr urine volume, and body weight were determined weekly during three weeks of streptozotocin-induced diabetes and for 5 weeks following transplantation of 250-3000 freshly isolated islets. At one week following transplantation, urine volume was inversely proportional to the mass of islets transplanted, but by 5 weeks posttransplantation urine volume was near-normal except in rats receiving only 250 islets. On the basis of the mean data, the nonfasted plasma glucose fell linearly at a rate of 66 mg/dl per week in rats receiving 500-1000 islets, with normoglycemia (147 +/- 9 mg/dl) being obtained 5 weeks posttransplantation. Examination of the individual time courses for nonfasted plasma glucose revealed a different pattern of glycemic normalization, which consisted of sustained hyperglycemia followed by a rapid fall in the plasma glucose level. During the week prior to normalization glucose fell at a rate of 170 mg/dl per week and normoglycemia was obtained from 1 to 5 weeks following transplantation. Examination of the frequency distribution of nonfasted glucose levels suggested a threshold of 300 mg/dl for glycemic normalization. We conclude that the dynamics of glycemic normalization following transplantation of a suboptimal islet mass include sustained hyperglycemia of variable duration, followed by a rapid fall in the nonfasted plasma glucose level. The contributions of changes in insulin secretion and insulin action underlying this dynamic behavior remain to be determined.

Animals↗

PubMed1992

Relationship of fetal macrosomia to maternal postprandial glucose control during pregnancy.

OBJECTIVE: To determine the gestational ages at which maternal hyperglycemia is most closely related to fetal macrosomia; to determine whether macrosomia is related to elevations of fasting glucose, postprandial glucose, or both; and to assess the relationship of macrosomia to maternal insulin dose and caloric intake. RESEARCH DESIGN AND METHODS: One hundred eleven consecutive pregnant women with Class B through RF diabetes were studied longitudinally from 13 to 36 wk gestation. Macrosomia was defined by birthweight greater than 90th percentile for gestational age based on California norms. Women who delivered macrosomic infants were compared with those without macrosomic infants on pre- and postprandial blood glucose, GHb, insulin dose, macronutrient intake, and several other maternal variables. RESULTS: Macrosomia occurred in 32 (29%) cases, although several measures indicated reasonable glycemic control throughout pregnancy. Women delivering macrosomic infants did not differ from those without macrosomic infants in maternal age, prepregnant weight, duration of diabetes, White class, macronutrient intake, GHb, or fasting glucose. Macrosomia was associated with higher postprandial glucose levels up to 32 wk gestation and lower insulin doses from 29 to 36 wk gestation. In multiple logistic regression, macrosomia was significantly associated with postprandial glucose only between 29 and 32 wk gestation. Postprandial glucose values less than 7.3 mM (less than 130 mg/dl) were associated with a higher risk of small-for-gestational-age infants (18%) compared with values above this level (1%). CONCLUSIONS: Because macrosomia was related to postprandial glucose but not fasting glucose, we conclude that postprandial glucose measurement should be a part of routine care for diabetes in pregnancy. A target 1-h postprandial glucose value of 7.3 mM (130 mg/dl) may be the level that optimally reduces the incidence of macrosomia without increasing the incidence of small-for-gestational-age infants.

Adult↗

PubMed1992

Daily stress variability, learned resourcefulness, regimen adherence, and metabolic control in type I diabetes mellitus: evaluation of a path model.

A model of daily stress and metabolic control in Type I diabetes was tested in which stress has dual effects upon glycemic level: (a) direct, through psychophysiological mechanisms, and (b) mediated, through regimen adherence. Learned resourcefulness was postulated to moderate both effects. Two approaches to measuring daily stress were also compared: stress mean and variability. Daily stress and adherence were measured in 62 adult diabetics on six occasions over 2 months, after which glycosylated hemoglobin levels were obtained. Stress had a direct association with metabolic control that was not mediated by adherence. Although learned resourcefulness failed to moderate this relationship, it did relate directly to metabolic control, in the unexpected direction. The variables combined to explain 37% of the variance in metabolic control. The utility of the intraindividual approach to daily stress measurement was supported.

Adaptation, Psychological↗

PubMed2026

OCT1 Variants Are Associated with Metformin Clearance and Gluconeogenesis: Mechanistic Insights for Youth-Onset Type 2 Diabetes in the MIGHTY Study.

AIMS/HYPOTHESIS: Behavioral and phenotypic characteristics do not fully explain variability in African Americans with youth-onset type 2 diabetes (Y-T2D) treated with metformin with or without liraglutide. We hypothesized that biological heterogeneity, including genetic variation in the metformin transporter OCT1, influences metformin pharmacokinetics and hepatic glucose flux. Therefore, we sought to characterize metformin pharmacokinetics in Y-T2D and evaluate genetic variants known to modulate metformin efficacy in adults to determine the mechanisms underlying variation in treatment response. METHODS: We evaluated genetic variants related to metformin transport and mechanisms of action in 30 Y-T2D using a candidate-gene approach to evaluate the association of pharmacogenetic variants with fasting glucose and gluconeogenesis. In a subset of Y-T2D randomized to 3 months of metformin (n=11) or metformin and liraglutide (n=8), we constructed a metformin population pharmacokinetic model and evaluated gene variant associations. RESULTS: A one-compartment first-order absorption and elimination pharmacokinetic model provided the optimal fit. Metformin pharmacokinetic parameters were similar by group and not related to glycemia. The rs628031_OCT1 A allele was associated with greater metformin clearance. The rs622342_OCT1 C allele was associated with lower post-treatment fractional gluconeogenesis (β [95% CI] = -8.8 [-14.13, -3.47] %, Adjusted R2 = 0.56, P = 0.003). The rs7903146_TCF7L2 T allele was associated with greater reductions in fasting glucose among those treated with metformin + liraglutide (β = -1.32 [-2.42, -0.22] mmol/L, Adjusted R2 = 0.8, P<0.002), but baseline glucose and gluconeogenesis (P<0.0001) were the strongest predictors of post-treatment glycemia. CONCLUSION/INTERPRETATION: In Y-T2D, OCT1 gene variants rs628031 and rs622342 were associated with metformin clearance and gluconeogenesis, respectively. TCF7L2 variant rs7903146 may contribute to differences in glycemic response in youth treated with metformin and liraglutide. These findings suggest genetic variants may be important for understanding variable metformin response in Y-T2D.

SLC22A1↗

PubMed1992

Screening for diabetic retinopathy.

PURPOSE: To determine the appropriate patients, methods, and timing for screening for diabetic retinopathy. DATA SOURCES: Relevant articles were identified through prominent review articles, the authors' files, recommendations from experts, and a MEDLINE search (1986 to the present); additional references were selected from the bibliographies of identified articles. STUDY SELECTION: Selection of articles on the natural history of retinopathy was limited to large clinical series and formal epidemiologic studies of defined populations. Selection of articles on the therapeutic effect of photocoagulation and of glycemic control was limited to randomized trials. Sources bearing on the accuracy of screening modalities were necessarily more varied. DATA EXTRACTION: For important variables, individual estimates from multiple studies are presented rather than a single meta-analytic summary estimate. RESULTS: Screening for retinopathy is justifiable if early detection leads to less vision loss at an acceptable cost. The evidence shows that 1) laser therapy reduces the rate of vision loss by 50% among patients with proliferative retinopathy and macular edema, conditions that are often asymptomatic; 2) duration of diabetes is the main risk factor for retinopathy; and 3) standard ophthalmoscopic examination has only moderate sensitivity (about 80% in research settings) and specificity (greater than 90% for proliferative retinopathy but lower for macular edema), making seven-field stereophotography a more accurate method. Estimates of cost effectiveness indicate that screening for retinopathy not only saves years of vision but may be cost saving from a societal perspective. CONCLUSIONS: Screening for retinopathy in patients with diabetes, and subsequent photocoagulation therapy for those who have high risk macular edema or proliferative retinopathy, is clearly beneficial.

Cost-Benefit Analysis↗

PubMed2026

A GRADE-assessed systematic review and meta-analysis of randomized controlled trials evaluating the effects of olive leaf or olive pomace supplementation on cardiometabolic and anthropometric health markers.

AIMS: Cardiometabolic diseases (CMDs) are major contributors to global morbidity and mortality, and dietary bioactives such as polyphenols may modulate key risk factors. Olive by-products, particularly olive leaves (OL) and olive pomace (OP), are rich in phenolic compounds with antioxidant, anti-inflammatory, and cardiometabolic effects demonstrated across in vitro, preclinical, and clinical studies. DATA SYNTHESIS: This GRADE-assessed systematic review and meta-analysis included 30 randomized controlled trials (n = 1726) evaluating OL or OP supplementation on 21 standardized biomarkers, encompassing inflammatory markers, lipid profile, glycemic control, insulin sensitivity, anthropometric measures, and blood pressure. Meta-analyses were conducted using random-effects models, with effect sizes calculated as mean differences (or standardized mean differences for oxLDL). Between-study heterogeneity was assessed with I2 statistics, and sensitivity and subgroup analyses explored potential sources of variability. Publication bias was evaluated using Begg's test and funnel plots where appropriate. OL supplementation significantly improved lipid parameters (total cholesterol, triglycerides, LDL-C, ApoB, oxLDL) and increased ApoA1, while reducing TNF-α, systolic and diastolic blood pressure, body weight, and BMI. No significant effects were observed on glycemic markers. OP supplementation showed no consistent cardiometabolic benefits and was associated with an increase in IL-8. Certainty of evidence ranged from very low to high, with several outcomes downgraded due to imprecision, heterogeneity, or limited study numbers. CONCLUSION: These findings support the targeted use of OL as an adjunctive strategy for cardiometabolic risk management. Evidence for OP supplementation remains limited, underscoring the need for well-powered, high-quality RCTs to clarify its clinical effects.

Humans↗

PubMed1992

Angiotensin-converting enzyme inhibitor therapy and diabetic retinopathy.

This pilot project suggested that angiotensin-converting enzyme (ACE) inhibitors may have an effect on delaying or reversing diabetic retinopathy. One patient who had Grade 5 (preproliferative) retinopathy improved to Grade 2 (microaneurysms only) after two years of treatment. Of the 450 patients followed in our eye and kidney clinic, no other patient showed a similar reversal from Grade 5 retinopathy without treatment. Improvement by one or more grades was seen in three other patients with variable grades of retinopathy after a mean of 3.3 years of treatment. Improvement was not related consistently to a decrease in blood pressure (0 of 4), better glycemic control (2 of 4), or reduction in albumin excretion rate (0 of 4). Proper double-blind controlled studies are needed to prove the effect of ACE inhibitors on diabetic microangiopathy of the eye.

Adolescent↗

PubMed1992

A longitudinal analysis of adherence and health status in childhood diabetes.

Applied structural equation modeling to a longitudinal data set of 193 youngsters with insulin-dependent diabetes mellitus assessed on two occasions, an average of 1.65 years apart. Six adherence constructs, Injection, Exercise, Diet Type, Testing-Eating Frequency, Calories Consumed, and Concentrated Sweets, were quantified from 24-hr recall interviews conducted with mother and child. Glycemic control was indexed by glycosylated hemoglobin (HA1C); lipid metabolism was indexed by fasting triglyceride levels (TRIG). The relationship of each adherence construct to metabolic control was tested separately. Patient age and disease duration served as exogenous variables in all models. Testing-Eating Frequency was associated with HA1C and Injection was associated with TRIG; in both cases better adherence was associated with better metabolic control. However, the standardized regression weights and variance accounted for were small. Patient age was a predictor of both adherence and metabolic control; older youngsters were less adherent and were in worse metabolic control. Inspection of models for younger versus older children suggested that age-homogeneous models improved prediction, but adherence and metabolic control linkages remained weak. Suggestions for refining the model are provided.

Blood Glucose↗

PubMed1992

Effect of improved diabetes control on the expression of lipoprotein lipase in human adipose tissue.

Patients with diabetes commonly manifest hypertriglyceridemia along with decreased adipose tissue lipoprotein lipase (LPL) activity, and improved diabetes control tends to reverse these abnormalities. To better understand the mechanism of regulation of LPL in diabetes, 11 diabetic patients (3 type I, 8 type II) were brought under improved glycemic control, and adipose tissue LPL gene expression was assessed by performing paired fat biopsies. Six of the 11 patients attained improved control with insulin, with a decrease in glycohemoglobin (glyc Hgb) from 13.8 +/- 0.9 to 10.4 +/- 0.6%; 5 patients attained improved control with glyburide (glyc Hgb fell from 14.2 +/- 2.4 to 8.8 +/- 0.6%), and together they demonstrated a lowering of serum triglycerides and total cholesterol. No changes were observed in HDL cholesterol. Improved diabetes control resulted in a significant increase in LPL activity in both the heparin-releasable (HR) and extractable (EXT) fractions of adipose tissue, as well as in LPL immunoreactive mass. The change in LPL activity with improved control was variable, and showed a positive correlation with the HDL levels prior to treatment (r = 0.74, P less than 0.02). When adipose tissue was pulse-labeled with [35S]methionine, there was an increase in isotope incorporation into LPL after treatment, indicating an increase in LPL synthetic rate. However, improved diabetes control resulted in no significant change in LPL mRNA levels. Thus, improved glycemic control resulted in an increase in LPL activity which correlated with each patient's basal high density lipoprotein. This increase in LPL activity was accompanied by an increase in LPL immunoreactive mass, and an increase in LPL synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗

PubMed1992

Quantitative and qualitative lipoprotein abnormalities in diabetes mellitus.

In people with diabetes, the concentration of an individual lipoprotein or apolipoprotein can be highly variable and is totally different in the two major forms of the disease. Alterations in the concentrations of major lipids and lipoproteins are well characterized in both IDDM and NIDDM. In general, the lipoprotein pattern is antiatherogenic in individuals with IDDM who are treated and have optimal glycemic control. In contrast, NIDDM is associated with atherogenic changes of serum lipids and lipoproteins regardless of the mode of treatment. In people with both types of diabetes, the distribution of apoE phenotype seems to be similar to that in nondiabetic populations. IDDM patients with microalbuminuria show atherogenic changes of lipoproteins and have elevated levels of Lp(a), which is a risk factor of coronary artery disease. Whether glycemic control influences the concentration of Lp(a) is still an open question. An important issue is that the concentration of a lipoprotein can be normal without excluding compositional abnormalities that are potentially atherogenic. Such alterations are present in people with both IDDM and NIDDM. Consequently, it has been questioned whether the target values to start treatment should be lower in diabetic than in nondiabetic populations.

Diabetes Complications↗