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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To test whether metformin treatment might improve peripheral insulin sensitivity in non insulin dependent diabetes, we measured peripheral glucose uptake in 12 non insulin dependent diabetics before (A) and after 4 weeks (B) of metformin therapy (2 X 850 mg/day) by the hyperinsulinemic clamp technique (80 mU/m2/min). In addition, insulin binding to monocytes was compared between A and B. Diabetic control, evaluated by measurement of fasting blood glucose and glycosylated hemoglobin, was significantly improved by metformin treatment (P less than 0.01). Insulin binding to monocytes was not significantly influenced by metformin (A-4.53% vs. B-5.12%, n.s. at insulin tracer concentration). Peripheral glucose utilisation improved slightly, but significantly after 4 weeks of metformin therapy (A: 4.4 +/- 0.6 mg/kg/min, B: 5.4 +/- 0.8 mg/kg/min, p less than 0.01). Improvement in peripheral glucose utilisation correlated significantly with improved metabolic control, estimated by fasting blood glucose measurements (p less than 0.01).
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PMID:Effect of metformin on peripheral insulin sensitivity in non insulin dependent diabetes mellitus. 381 57

The effects of nifedipine (Adalat) on glucose metabolism and insulin release were studied in rats and in patients with type 2 diabetes mellitus complicated with hypertension. 1. In rats, 2.5-50 micrograms/kg of intravenous nifedipine reduced glucose tolerance and insulin release after intravenous glucose in a dose related fashion, although fasting blood sugar and insulin were not affected at 50 micrograms/kg of nifedipine. 2. Daily 20 to 60 mg of oral nifedipine for 12-75 weeks to 14 type 2 diabetics with hypertension did not affect their fasting blood glucose or hemoglobin A1. Mean glucose tolerance curve after the treatment was significantly ameliorated, although insulin response during the oral glucose loading did not show any significant change. Those results suggest firstly that there may be a difference in insulinopenic effect of nifedipine between the species, and secondly that long-term administration of nifedipine produced no adverse influence on glucose metabolism in type 2 diabetics.
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PMID:Effects of nifedipine on insulin secretion and glucose metabolism in rats and in hypertensive type 2 (non-insulin dependent) diabetics. 388 27

Type II diabetes mellitus is a heterogeneous disease. Selection of either insulin or a sulfonylurea agent in addition to diet is usually made empirically. In patients who fail to respond to either agent alone, the potential benefit of combined insulin and sulfonylurea therapy is unclear. We therefore evaluated nine poorly controlled insulin treated type II diabetic patients after addition of a sulfonylurea agent--glyburide--for four weeks. Glycosylated hemoglobin (HbA1c), serum glucose, and C-peptide responses to oral glucose were evaluated. Based on a reduction of at least 50 mg/dl in the fasting serum glucose (FSG) at the end of the first week of the combination therapy or a FSG of less than 140 mg/dl, two groups were arbitrarily identified: responders (n = 5) and nonresponders (n = 4). Clinical characteristics including mean age, weight, duration of diabetes, daily dose of insulin, and duration of insulin treatment were not statistically different between the two groups. Mean baseline FSG and HbA1c levels were also not statistically different in both groups. An improvement in mean FSG and glucose tolerance occurred in the responders at the end of four weeks of combined therapy (FSG: 291 +/- 25 vs. 189 +/- 6 mg/dl, p less than 0.05; HbA1c 10.76 +/- 0.80 vs. 9.40 +/- 0.21%, p = NS). The nonresponders had no change in glucose tolerance. The mean fasting and stimulated serum C-peptide levels were significantly higher in the responders at week 4 compared with that of the nonresponders.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Serum C-peptide levels determine glycemic responses in type II diabetic patients treated with combined insulin and sulfonylurea agent. 392 Sep 7

A randomized double-blind, placebo-controlled trial of insulin plus glyburide was carried out in 22 insulin-treated patients with poorly controlled type II diabetes mellitus. Glycemic control and lipoprotein responses were assessed for 16 weeks. Oral glucose tolerance testing was performed at weeks 0, 4, and 16. Clinical characteristics and glycemic control were similar at week 0 in the placebo/insulin group (n = 12) and the glyburide/insulin group (n = 10). Throughout the study, the dose of insulin was fixed. The placebo group had no change in any metabolic parameter throughout the protocol period. After four weeks, glyburide significantly lowered fasting blood glucose and integrated glucose areas (p less than 0.01) after oral glucose testing compared with week 0 (fasting blood glucose 225 +/- 20 mg/dl versus 286 +/- 27 mg/dl, p less than 0.02). Associated with this were mean fasting, stimulated, and integrated C-peptide levels that were significantly higher (p less than 0.02) at week 4 versus week 0. After 16 weeks, mean fasting blood glucose remained significantly lower compared with baseline values (252 +/- 25 mg/dl versus 286 +/- 27 mg/dl, p less than 0.05). Glycosylated hemoglobin (hemoglobin A1c) levels decreased significantly (p less than 0.05) at weeks 4 to 16 compared with the baseline value. Although integrated areas were no different after oral glucose, fasting and stimulated C-peptide levels were significantly higher (p less than 0.05) at week 16 versus week 0. Total cholesterol, triglycerides, low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol did not change during the study. After the code was broken, comparisons were made between those with response to combination therapy (reduction of fasting blood glucose by at least 50 mg/dl or fasting blood glucose of 140 mg/dl or less at the end of the first week of treatment that persisted for four consecutive weeks) and those without response. Baseline clinical and laboratory characteristics were identical in both groups. Mean fasting and stimulated serum C-peptide levels after oral glucose, however, were significantly higher in the patients with response at week 4 compared with the patients without response. The mean maximal incremental C-peptide level was 1.50 +/- 0.19 ng/ml at week 0 in the patients with response compared with 0.67 +/- 0.28 ng/ml in the patients without response (p less than 0.01). Lipoproteins were not different in the two groups.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Combination insulin/glyburide therapy in type II diabetes mellitus. Effects on lipoprotein metabolism and glucoregulation. 393 67

We instructed pregnant women with insulin dependent diabetes mellitus (IDDM) or noninsulin dependent diabetes mellitus (NIDDM) how to monitor their own blood glucose concentrations and evaluated the efficiency and feasibility of continuous subcutaneous insulin infusion (CSII) therapy. Self-monitored glucose concentrations with a reflectance meter correlated with those of hospital laboratory measurements (hexokinase method) with a coefficient of more than 0.9. Glycosylated hemoglobin (HbA1) levels of the patients were normalized with insulin treatment based on the self-monitored glucose concentrations. In pregnant women with NIDDM who monitored their blood glucose concentrations before breakfast, the fasting glucose concentrations could be lowered by insulin administration and the duration of hospitalization could be shortened compared to non-monitored patients. Although diurnal variations were prominent in pregnant women with IDDM and precise control of their blood glucose concentrations was difficult with conventional insulin administration, even if the patients had monitored their glucose concentrations 7 times a day, the mean glucose concentrations and M values could be kept in the optimum range in patients treated with CSII. These methods have contributed to the improvement in maternal and infant complications.
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PMID:[Assessment of self monitoring of blood glucose (SMBG) and continuous subcutaneous insulin infusion (CSII) in diabetic pregnant women]. 408 5

This study was designed to determine: (1) the effectiveness and safety of protein-sparing fast and gastric bypass surgery for achieving weight reduction in obese patients with type II diabetes mellitus (non-insulin-dependent diabetes mellitus); (2) the effects of these interventions on glycemic control; (3) the effects of weight loss on insulin secretion and action; and (4) the effects of treatment on atherosclerotic risk factors. Six patients consumed only a protein supplement (1.4 g/kg ideal body weight) for up to six months until a final weight below 120 percent of ideal body weight was achieved or weight loss ceased. Six patients underwent gastric bypass surgery. Both groups of patients were studied before and after treatment while consuming a balanced weight-maintaining diet. Both protein-sparing fast and gastric bypass surgery were safe and successful in the short term in producing weight loss. Both treatments improved glycemic control. Mean fasting plasma glucose values fell from 287 to 168 mg/dl (p less than 0.01). Mean total glycosylated hemoglobin values declined from 11.9 to 8.2 percent (p less than 0.01) (normal reference interval 5.85 to 8.85 percent). Patients who achieved a final weight below 125 percent of ideal body weight had significantly better post-treatment fasting plasma glucose values (130 versus 196 mg/dl, p less than 0.05) and total glycosylated hemoglobin values (6.8 versus 9.0, p less than 0.02) than those whose weight remained above 125 percent of ideal. In diet-treated patients, improved glycemic control occurred with caloric restriction alone prior to significant weight loss. Improved glycemic control was accompanied by decreased insulin resistance. Mean steady-state plasma glucose values fell from 377 to 208 mg/dl (p less than 0.008), and mean fasting insulin values fell from 31.0 to 17.0 microU/ml (p less than 0.004). Acute-phase insulin release, which was markedly impaired before treatment, did not improve even in patients who had post-treatment fasting plasma glucose values below 130 mg/dl. Significant improvements in atherosclerotic risk factors occurred. Mean high-density lipoprotein cholesterol values increased from 33.8 to 40.5 mg/dl (0.006 less than p less than 0.008), and factor VIII coagulant activity decreased from 194 to 140 percent (p less than 0.005). Serum fibrinogen also decreased (393 to 347 mg/dl, p = 0.08), although the decrease did not reach clinical significance.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Effects of caloric restriction and weight loss on glycemic control, insulin release and resistance, and atherosclerotic risk in obese patients with type II diabetes mellitus. 637 92

Recent evidence suggests concomitant insulin and sulfonylurea therapy has a theoretical potential in the management of type II diabetes mellitus. In a long-term double-blind, randomized placebo-controlled study of combination therapy, serum glucose, C-peptide, total cholesterol, triglyceride, low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol concentrations were evaluated in insulin-treated patients with poorly controlled, type II diabetes mellitus after addition of either glyburide (n = 10) or placebo (n = 12). Oral glucose tolerance testing was performed at weeks 0, 4, and 16. Clinical characteristics and glycemic control (fasting blood glucose and glycosylated hemoglobin values) were similar at week 0 in both groups. The placebo group had no change in any metabolic parameter throughout the study period. At week 4, glyburide significantly lowered fasting blood glucose and integrated glucose areas (p less than 0.01) compared with values at week 0 (fasting blood glucose 225 +/- 20 versus 286 +/- 27 mg/dl, p less than 0.02). Mean fasting, stimulated, and integrated C-peptide levels were significantly higher (p less than 0.02) at week 4 versus week 0. At week 16, mean fasting blood glucose values remained significantly lower compared with baseline values (252 +/- 25 versus 286 +/- 27 mg/dl, p less than 0.05). Glycosylated hemoglobin levels decreased significantly (p less than 0.05) at weeks 4 to 16 compared with the baseline values. Although glucose responses and integrated areas were no different after oral glucose tolerance testing, fasting and stimulated C-peptide levels were significantly higher (p less than 0.05) at week 16 versus week 0. Lipid and lipoprotein levels remained unchanged. In summary, combination therapy consisting of glyburide and insulin moderately improved glucose control in type II diabetes mellitus at the end of four weeks. Despite significantly lower fasting serum glucose and glycosylated hemoglobin levels after 16 weeks, combination treatment did not normalize glycemic control. Glucose tolerance decreased further after 16 weeks despite persistence of increased endogenous insulin secretion. The role of the combination therapy in the long-term care of patients with type II diabetes mellitus needs further investigation.
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PMID:Concomitant insulin and sulfonylurea therapy in patients with type II diabetes. Effects on glucoregulation and lipid metabolism. 643 36

The suggestion of a role for the abnormally regulated growth hormone (GH) in the pathogenesis of diabetes mellitus (DM), implicates also the somatomedins, as mediators of some of GH actions. The present study was aimed at assessing the somatomedin response to exogenous GH administration in diabetes type II (NIDDM) subjects as well as its possible relationship with the degree of control of diabetes. Twenty-two subjects (seven controls and 15 NIDDM patients), matched for sex and age, underwent human GH infusion (0.1 U/kg b.w.) over a one-hour period (time 0 to 1 hour). Total somatomedins (SMs) were measured by human placental membrane radioreceptor assay (in which all SMs crossreact) and Somatomedin-C (SM-C) was determined by a specific RIA. Values were obtained from plasma samples at times 0, 1, 4, 6, and 24 hours. Glycosylated hemoglobin (HbA1a-c) measurements were done from blood samples obtained at time 0. The increase in SMs following GH infusion in NIDDM group was not significantly different from that of the controls. In contrast, the SM-C increase at time 6 and 24 hours were significantly higher than in controls (p less than 0.05 and p less than 0.01, respectively). No significant difference was found between SMs or SM-C response to GH infusion in patients with HbA1a-c greater than 10% vs. less than 10%. These results indicate an exaggerated and prolonged increase in SM-C synthesis following exogenous GH infusion in NIDDM subjects, apparently unrelated to the degree of control of diabetes.
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PMID:Exaggerated somatomedin-C response to human growth hormone infusion in patients with type II diabetes mellitus. 653 51

This study reviews the new diagnostic criteria for diabetes mellitus proposed by NIH. We measured insulin levels during 75 g oral glucose tolerance test (75 g OGTT) and hemoglobin AIC levels in patients diagnosed as having impaired glucose tolerance (IGT) or non-insulin dependent diabetes (NIDDM) according to the NIH criteria. In a 75 g oral glucose tolerance test, there was no significant difference in insulin-glucose ratio between nonobese IGT and nonobese NIDDM who had fasting blood glucose levels of less than 120 mg/dl (NIDDM-A group). However, in nonobese NIDDM with fasting blood glucose higher than 120 mg/dl (NIDDM-B group), the insulin-glucose ratio was significantly lower than in the IGT or NIDDM-A group. The NIDDM-B group had a higher hemoglobin AIC levels than the IGT and NIDDM-A groups, with no significant difference between the levels of the two latter groups. These observations suggest that the impairment in the function of pancreatic B cells and the state of chronic hyperglycemia are the same in IGT & NIDDM-A groups. Therefore, the NIH standards do not appear refined enough to truly differentiate between IGT and nonobese NIDDM with fasting blood glucose of less than 120 mg/dl.
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PMID:An assessment of the new NIH diagnostic criteria for diabetes mellitus according to insulin response in a 75 g oral glucose tolerance test and levels of hemoglobin AIC. 675 57

Interpreting measurements of fasting plasma glucose (FPG) and glycosylated hemoglobin (GHb) is subject to inherent limitations. The time course of change in GHb cannot be reliably specified in the individual patient, nor do single measurements of GHb convey any information regarding recent change or stability in glycemic control. To evaluate whether the clinical utility of these measurements may be extended, sequential measurements of FPG and GHb were examined from 16 outpatients with NIDDM followed over periods of 12 successive weeks or longer, including intervals following cessation of prior therapy or initiation of new hypoglycemic therapy with glipizide. In some individuals as well as groups of patients, changes in GHb followed patterns previously described by mean changes among groups of patients. Differing from those patterns, however, other individuals demonstrated prompt improvement in GHb following substantial improvement in FPG, confirming that patterns of change described from group means do not apply to all circumstances of changing glycemic control, though they may represent the most common. By using measurements of both FPG and GHb obtained on a single occasion to calculate a third parameter, called the glycosylated hemoglobin index (GHb-1), accurate information could be obtained regarding changes in glycemic control which occurred over intervals of 1-4 wk prior to the measurements. By this approach the utility of GHb measurements in the management of outpatients with NIDDM may be extended beyond retrospective description of the "average" prior metabolic control to include assessment of recent changes in glycemia, either deterioration or improvement.
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PMID:Glycosylated hemoglobin and fasting plasma glucose in the assessment of outpatient glycemic control in NIDDM. 692 29


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