Early identification and treatment of insulin resistance: impact on subsequent prediabetes and type 2 diabetes.

Insulin resistance (IR) is characterized by decreasing sensitivity of target tissues to the action of insulin, elevated blood glucose concentration, and increased hepatic production of atherogenic lipids. IR is associated with declining insulin production by the pancreas, the emergence of type 2 diabetes, and increasing risk of cardiovascular disease (CVD). Clinical markers of IR include elevated plasma glucose concentration under fasting conditions or following ingestion of an oral glucose challenge.

Prevalence of bone mineral disease among adolescents with cystic fibrosis.

Objective: To evaluate the prevalence of bone mineral disease among adolescents with cystic fibrosis and to relate the findings with the variables studied.

Methods: The study enrolled 37 adolescents who were assessed for: nutritional status according to height/age and body mass/age ratios; bone mineral density of the lumbar spine and entire body by densitometry with dual emission X-ray; daily dietary intake according to a 3-day dietary recall; and pulmonary function by the forced expiratory volume in one second test.

Results: Mean age was 13.

Lowering blood pressure with beta-blockers in combination with other renin-angiotensin system blockers in patients with hypertension and type 2 diabetes: results from the GEMINI Trial.

The effects of beta-blockade in addition to more specific renin-angiotensin system (RAS) blockers on blood pressure (BP) in patients with diabetes are described. After washout of medications other than angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, patients were titrated to a BP level <130/80 mm Hg using therapy with carvedilol 6.25 to 25 mg bid (n=498) or metoprolol tartrate 50 to 200 mg bid (n=737).

Rationale for the use of insulin sensitizers to prevent cardiovascular events in type 2 diabetes mellitus.

Cardiovascular events in patients with type 2 diabetes mellitus are a major problem in clinical practice, and patients with diabetes have derived less benefit from advances in preventive and interventional cardiology. Tighter goals for metabolic management and attention to nontraditional risk factors may be needed in this patient group. Insulin resistance rather than hyperinsulinemia is thought to underlie cardiovascular disease in patients with diabetes.

The long-term survival of simultaneous pancreas and kidney transplant with basiliximab induction therapy.

Interleukin-2 receptor (IL2R) antibody has emerged as an attractive induction therapy for organ transplant. However, the long-term outcome of basiliximab induction in simultaneous pancreas and kidney (SPK) transplant remains speculative. We retrospectively analyzed the long-term survivals of 91 consecutive SPK recipients with basiliximab as induction, combination of steroid, tacrolimus (TAC) and mycophenolate acid (MFA)--either mycophenolate mofetil (MMF) or sodium mycophenolate (myfortic) as maintenance.

DPP-4 inhibitors as a new target of action for Type 2 diabetes mellitus: a focus on vildagliptin.

The purpose of this review is to highlight the role of the incretin system and discuss the role of dipeptidyl peptidase (DPP)-4 inhibitors as potential treatment for diabetes, drawing attention to some of the available clinical trial data that support the use of such agents. The DPP-4 enzyme is involved in the breakdown of glucagon-like peptide (GLP)-1, an incretin that has a very short half-life. DPP-4 inhibitors delay the degradation of GLP-1, in turn extending the action of insulin and suppressing the release of glucagon.

[Association between phase angle, PRISM I and sepsis severity].

Background And Objectives: Phase angle (PA) is the difference between voltage and current and can be used as an indicator of body cell mass. Clinical studies show that low phase angle is associated with morbidity and mortality of critical patients. The purpose of this study was to know the relation between phase angle and the Pediatric Risk of Mortality I (PRISM I) score, associating this score with the severity of sepsis.

Identification of an osteopontin-like protein in fish associated with mineral formation.

Fish has been recently recognized as a suitable vertebrate model and represents a promising alternative to mammals for studying mechanisms of tissue mineralization and unravelling specific questions related to vertebrate bone formation. The recently developed Sparus aurata (gilthead seabream) osteoblast-like cell line VSa16 was used to construct a cDNA subtractive library aimed at the identification of genes associated with fish tissue mineralization. Suppression subtractive hybridization, combined with mirror orientation selection, identified 194 cDNA clones representing 20 different genes up-regulated during the mineralization of the VSa16 extracellular matrix.

Cardiovascular effects of peroxynitrite.

1. Peroxynitrite (PN) is formed in biological systems from the reaction of nitric oxide (*NO) with superoxide (O2(-)*) and both exist as free radicals. By itself, PN is not a free radical, but it can generate nitrogen dioxide (*NO2) and carbonate radical (CO3(-)*) upon reaction with CO2.

Severe hypoglycemia monitoring and risk management procedures in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

Hypoglycemia is a potentially serious side effect of blood glucose lowering in diabetes mellitus. The intensive glycemia treatment arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial is designed to treat patients with type 2 diabetes with target glycemia within the normal range (ie, glycosylated hemoglobin <6%). Because it is known that treating glycemia to such a low level in patients with diabetes will result in episodes of hypoglycemia, it is necessary to address prevention and treatment of such episodes to ensure patient safety.

Body weight changes with beta-blocker use: results from GEMINI.

Purpose: Patients with type 2 diabetes are commonly overweight, which can contribute to poor cardiovascular outcomes. beta-blockers may promote weight gain, or hamper weight loss, and are a concern in high-risk patients. The current analysis of the Glycemic Effect in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial evaluates the effects of carvedilol and metoprolol tartrate on weight gain in patients with type 2 diabetes and hypertension.

Body mass index and waist circumference as markers of arterial hypertension in adolescents.

Objective: To evaluate the sensitivity and specificity of anthropometric measurements of body fat in a sample of Brazilian adolescents for the prediction of hypertension.

Methods: The arterial blood pressure was measured on two visits in a sample of 456 students aged 12 to 17 years, from public and private schools of the Fonseca neighborhood, in Niterói, between 2003 and 2004. A subject was defined as hypertensive if he/she had systolic and diastolic pressures above the 95th percentile for sex, age and height.

A comparison of long-term survivals of simultaneous pancreas-kidney transplant between African American and Caucasian recipients with basiliximab induction therapy.

African Americans (AA) have traditionally been thought to have higher immunologic risk than Caucasians (CA) for rejection and allograft loss. The impact of ethnicity on the outcome of simultaneous pancreas-kidney (SPK) transplant with basiliximab induction has not been reported. In this study, we retrospectively analyze the long-term results of 36 AA and 55 CA recipients of primary SPK.

Differential effect of beta-blocker therapy on insulin resistance as a function of insulin sensitizer use: results from GEMINI.

Aims: To determine whether the beneficial effects of carvedilol on insulin resistance (IR) are affected by the concomitant use of insulin sensitizers [thiazolidinediones (TZDs) and metformin].

Methods: Changes in HbA1c and homeostasis model assessment-insulin resistance (HOMA-IR) were assessed over 5 months, comparing carvedilol with metoprolol tartrate according to insulin sensitizer (TZDs and metformin) use.

Results: In TZD/metformin users, carvedilol patients showed a 5.

beta-blocker use and diabetes symptom score: results from the GEMINI study.

Aim: The Glycemic Effect in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial compared the metabolic effects of two beta-blockers in people with type 2 diabetes and hypertension treated with renin-angiotensin system (RAS) blockade and found differences in metabolic outcomes. In this paper, we report the results of a prespecified secondary analysis of GEMINI that sought to determine the effect of these two beta-blockers on commonly reported symptoms.

Methods: The Diabetes Symptom Checklist (DSC), a self-report questionnaire measuring the occurrence and perceived burden of diabetes-related symptoms, was completed by GEMINI participants at baseline and at the end of the study (maintenance month 5).

Addition of vildagliptin to insulin improves glycaemic control in type 2 diabetes.

Aims/hypothesis: Type 2 diabetes is difficult to manage in patients with a long history of disease requiring insulin therapy. Moreover, addition of most currently available oral antidiabetic agents increases the risk of hypoglycaemia. Vildagliptin is a dipeptidyl peptidase-IV inhibitor, which improves glycaemic control by increasing pancreatic beta cell responsiveness to glucose and suppressing inappropriate glucagon secretion.

Assessing anthropogenic pressures on estuarine fish nurseries along the Portuguese coast: a multi-metric index and conceptual approach.

Estuaries are among the most productive ecosystems and simultaneously among the most threatened by conflicting human activities which damage their ecological functions, namely their nursery role for many fish species. A thorough assessment of the anthropogenic pressures in Portuguese estuarine systems (Douro, Ria de Aveiro, Mondego, Tejo, Sado, Mira, Ria Formosa and Guadiana) was made applying an aggregating multi-metric index, which quantitatively evaluates influences from key components: dams, population and industry, port activities and resource exploitation. Estuaries were ranked from most (Tejo) to least pressured (Mira), and the most influential types of pressure identified.

Management of diabetes in the hospital.

Hyperglycemia is a common complication in hospitalized patients, particularly among patients with acute myocardial infarction. It is an independent predictor of cardiovascular mortality and morbidity. Management of hyperglycemia with intensive insulin therapy has been shown to improve survival, reduce length of stay in intensive care, and decrease complications such as renal failure or prolonged mechanical ventilation in critically ill patients.

Topical mitomycin C effect on swine vocal folds healing.

Unlabelled: Several adjuvant therapies to surgery have been used to modulate the healing process of vocal folds, including topic mitomycin (MTC).

Aim: to evaluate the effect of topical MTC in the healing process of vocal folds 30 days after the exeresis of a mucosal fragment with CO2 laser in a swine model (control group without mitomycin and study group with topical MTC), with collagen deposition measurement.

Study Type: prospective experimental in swine.

Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association.

The American Heart Association (AHA) and the American Diabetes Association (ADA) have each published guidelines for cardiovascular disease prevention: The ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. This statement will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which AHA and ADA recommendations differ.

Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association.

The American Heart Association (AHA) and the American Diabetes Association (ADA) have each published guidelines for cardiovascular disease prevention: the ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. This statement will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which AHA and ADA recommendations differ.