The impact of testosterone replacement therapy on glycemic control,vascular function,and components of the metabolic syndrome in obese hypogonadal men with type 2 diabetes

Objective: This study set out to assess effects of testosterone replacement therapy (TRT) on parameters of metabolic syndrome and vascular function in obese hypogonadal males with type 2 diabetes mellitus (DM2).

Study design: Fifty-five obese hypogonadal diabetic males on oral hypoglycemic treatment were enrolled into this one-year, double-blind, randomized, placebo-controlled clinical study. Group T (n?=?28) was treated with testosterone undecanoate (1000?mg i.m. every 10?weeks) while group P (n?=?27) received placebo.

Methods: Anthropometrical and vascular measurements – flow-mediated dilatation (FMD) and intima media thickness (IMT) – biochemical and hormonal blood sample analyses were performed at the start of the study and after one year. Derived parameters (BMI, HOMA-IR, calculated free testosterone (cFT) and bioavailable testosterone (BT)) were calculated.

Results: TRT resulted in reduction of HOMA-IR by 4.64?±?4.25 (p?p?p?=?.005).

Conclusion: TRT normalized serum testosterone levels, improved glycemic control and endothelial function while exerting no ill effects on the study population.     

Total testosterone levels are correlated to metabolic syndrome components

Introduction: Metabolic syndrome (MetS) is a constellation of interrelated risk factors of metabolic origin. Some studies suggest a possible link between low total testosterone (TT) levels and the presence of MetS.

Aim: To analyze the strength and independence of associations between TT and MetS components in non-diabetic men.

Methods: In this cross-sectional study, 143 non-diabetic men older than 40 were analyzed.

Main outcomes measure: Blood samples were collected to evaluate metabolic profile and TT levels. MetS was defined as the presence of three or more of the following characteristics: fasting blood glucose levels?≥?100?mg/dL, triglyceride?≥?150?mg/dL, HDL-c??102?cm.

Results: Mean age of the study population was 61.5?±?8.61 years old. MetS was present in 47.9% of the individuals. Thirty-four men had low TT and MetS was observed in 23 (70%) against 50 (46%) in those with normal TT (≥?300?ng/dL) (OR 4.94, p?p?=?0.03) and HDL-c (Beta: 0.19; p?=?0.04) remained significantly correlated with TT levels.

Conclusions: Low TT levels were associated with MetS diagnosis. Abdominal obesity was the MetS component independently correlated to low TT levels.     

Tracking weight change,insulin resistance,stress, and aerobic fitness over 4 years of college

Objective: To determine if weight gain is accompanied by development of insulin resistance (IR) during 4 years in college. Participants: Two cohorts of college students were enrolled in fall semesters 2009 and 2010 and tracked for 4 years. Methods: Following a 12-hour fast, subjects reported for measurement of body mass index (BMI), perceived stress (PSS), aerobic fitness, and blood glucose, insulin, and lipids. Results: In the first year, 33% of subjects were overweight or obese, and 20% were hyperinsulinemic. Year 4 had 29 remaining subjects with disproportionate attrition of overweight and obese individuals. Just over half the subjects gained weight (WI), whereas nearly 30% lost considerable amounts (WD). WD showed significant decline in fasting insulin, low-density lipoprotein (LDL) cholesterol, and PSS from year 1. WI was primarily highly fit men who did not demonstrate increased IR. Conclusion: WI was not associated with IR over 4 years of college.     

降糖药物——阿尔茨海默病治疗的新思路

流行病学研究表明2型糖尿病（type 2 diabetes mellitus T2DM）能够增加患者发生阿尔茨海默病（Alzheimer＇s disease,AD）的风险。进一步的分子机制研究也表明,胰岛素抵抗以及胰岛素缺乏,这个T2DM特征性和最主要的发病机制也在AD的发病机制中发挥着重要作用。近年来甚至有人提议将AD称作＂3型糖尿病＂。基于这些研究,降糖药物也许是治疗AD的一个新选择。大量的临床试验研究也已经表明AD患者能够从降糖药物中获益,本文将主要介绍胰岛素、二甲双胍、噻唑烷二酮类药物以及胰升糖素样多肽1类似物。     

Demographic and Organizational Variables That Affect Southeastern College and University Student Health Promotion

Abstract

This study examined the relationship between demographic and organizational variables and college student health promotion efforts. Two hundred and forty-one college administrators from 14 southern states were surveyed to determine factors that may affect college student health promotion programming. Enrollment, tuition, affiliation, and highest degree offered were the demographic variables that were examined. The organizational variables were goals, control, motivation, interaction, and decision making. The methods of gathering information regarding student health problems, the kinds of health promotion programs offered, the methods of publicizing the programs, and the extent of student participation in health promotion programs were the dependent variables.

The statistical tests for the effects of the demographic and organizational variables on student health promotion efforts indicate that a relationship does exist. Combined multiple regression analysis equations that include all of the organizational variables demonstrated graphically the effects of interaction among the independent organizational variables and the dependent variables. These combined equations were better predictors of student health promotion programs and services than any of the organizational variables taken separately. Future studies of the factors that affect student participation in health promotion programs, the extent of student participation, and the effects of a student participation should be conducted.     

Hypogonadotrophic hypogonadism in type 2 diabetes

Recent work shows a high prevalence of low testosterone and inappropriately low luteinizing hormone (LH) and follicle stimulating hormone (FSH) concentrations in type 2 diabetes. This syndrome of hypogonadotrophic hypogonadism (HH) is associated with obesity in patients with type 2 diabetes. However, the duration of diabetes or HbA1c are not related to HH. Furthermore, recent data show that HH is not associated with type 1 diabetes. C-reactive protein concentrations have been shown to be elevated in patients with HH and are inversely related to plasma testosterone concentrations. This inverse relationship between plasma free testosterone and C- reactive protein concentrations in patients with type 2 diabetes suggests that inflammation may play an important role in the pathogenesis of this syndrome. This is of interest since inflammatory mechanisms may have a cardinal role in the pathogenesis of insulin resistance. It is also relevant that in the mouse, deletion of the insulin receptor in neurons leads to HH in addition to a state of systemic insulin resistance. It has also been shown that insulin facilitates the secretion of gonadotrophin releasing hormone (GnRH) from neuronal cell cultures. Thus, HH may be the result of insulin resistance at the level of the GnRH secreting neuron. Low testosterone concentrations are also related to an increase in total and regional adiposity. This review discusses these issues and attempts to make the syndrome relevant as a clinical entity. Clinical trials are required to determine whether testosterone replacement alleviates insulin resistance and inflammation. In addition, low testosterone levels are associated with an increase in cardiovascular events. Testosterone therapy may therefore, reduce cardiovascular risk. This important aspect requires further investigation.     

不同脂类饮食对血糖和胰岛素的影响

目的一些研究对2型糖尿病饮食脂类的推荐是基于空腹血脂和血糖的水平,然而脂肪酸对餐后血糖和胰岛素的影响却不清楚。本文的目的是旨在探索脂肪酸对餐后血糖和胰岛素的反应。方法 20例2型糖尿病患者服用含1000千卡热能的饮食,分别含棕榈油、橄榄油和鲑鱼油共7天,而后在360分钟内测其血糖和胰岛素水平。结果服用棕榈油的胰岛素水平明显高于服用橄榄油和鲑鱼油者。结论不同的脂肪酸可能有潜在的亲胰岛素作用。     

线粒体与胰岛素抵抗和糖尿病关系的研究进展

2型糖尿病以胰岛素抵抗为病理基础。虽然膳食、生活方式等环境因素仍被认为是糖尿病的发病中的重要决定因素,但是糖尿病具有明显的家族遗传学基础,而线粒体基因组某些位点的点突变、缺失突变和重复突变均被证明与糖尿病发生密切相关。     

稳态模型法测定糖尿病及非糖尿病终末期肾病患者胰岛素抵抗及其与血管疾病的关系

目的胰岛素抵抗在2型糖尿病及终末期肾病很常见,与动脉粥样硬化的进展有关,并且是糖尿病及终末期肾病心血管疾病的独立预测因素,为此,我们采用稳态模型测定胰岛素抵抗指数(HOMA-IR)来判断胰岛素抵抗并观察其与糖尿病以及非糖尿病终末期肾脏病患者血管疾病的关系。方法共有62名终末期肾脏病患者,其中2型糖尿病患者29人,应用血糖及胰岛素水平来估计胰岛素抵抗,此外,同时检测血浆C肽、HbAlc、甘油三脂、总胆固醇、C反应蛋白和血压。结果与非糖尿病组相比,糖尿病组中位HOMA-IR明显升高[6.3(range0.7-61.7)vs.2.4(range0.3-5.7),P<0.001]。HOMA-IR升高的患者收缩压及甘油三脂明显升高,而高密度脂蛋白明显降低。只有在非糖尿病组中,HOMA-IR升高患者与HOMA-IR降低患者相比,C肽明显升高(14.9 5.7vs.9.0 4.3,P=0.004)。在糖尿病组,HOMA-IR升高患者与HOMA-IR降低患者相比,血管疾病明显增多。结论在终末期肾病,糖尿病患者比非糖尿病患者的HOMA-IR更常见、更严重。降低的高密度脂蛋白是糖尿病患者HOMA-IR升高的唯一预测因素,而在非糖尿病患者则为升高的C肽。在终末期肾病患者中,血管疾病与升高的HOMA-IR有关。     

胰高血糖素样肽-1对胰岛β细胞功能的影响

目的观察胰高血糖素样肽-1（glucoincretin hormone glucagon-likepeptide-1,GLP-1）对RIN-m细胞分泌功能的影响。探讨GLP-1对链脲佐菌素诱导胰岛细胞凋亡的保护机制。方法应用TUNEL法检测RIN-m细胞凋亡的百分率;RT—PCR检测PDX-1,bcl-2／baxmRNA的表达。结果GLP-1在高糖培养下可以延缓RIN-m细胞随体外培养时间延长而出现的胰岛素和胰十二指肠同源盒基因转录因子1（PDX-1）．RNA水平的下降,且其作用具有葡萄糖依赖性。GLP-1可以保护低剂量链脲佐菌素使RIN—m细胞凋亡细胞比例明显减少,凋亡过程中,baxmRNA表达水平明显降低,bcl-2mRNA表达水平明显上升。结论由此推测GLP—1可能通过PDX-1延缓RIN—m细胞胰岛素分泌功能的下降,同时GLP＋1可以保护低剂量链脲佐菌素通过诱导胰岛细胞凋亡导致糖尿病,其中bcl＋2／baxmRNA表达比率变化可能起重要作用。