Growth hormone deficiency and cardiovascular risk.

It is now recognized that growth hormone (GH) deficiency in adults represents a distinct clinical syndrome that encompasses reduced psychological well-being as well as specific metabolic abnormalities. The latter features, which include hypertension, central obesity, insulin resistance, dyslipidaemia and coagulopathy, closely resemble those of metabolic insulin resistance syndrome. The increased cardiovascular morbidity and mortality demonstrated in these GH-deficient (GHD) adults reinforce the close association between the two syndromes. Replacement of GH in GHD adults has resulted in a marked reduction of central obesity and significant reduction in total cholesterol but little change in other risk factors, in particular insulin resistance and dyslipidaemia. The persistent insulin resistance and dyslipidaemia, together with the elevation of plasma insulin levels and lipoprotein (a) with GH replacement in these subjects are of concern. Long-term follow-up data are required to assess the impact of GH replacement on the cardiovascular morbidity and mortality of GHD adults. Further exploration of the appropriateness of the GH dosage regimens currently being employed is also indicated

Depression, hormonal status and erectile dysfunction in the aging male: results from a community study in Malaysia

Background: Depression and erectile dysfunction (ED) are common in aging and the two conditions often co-exist. These conditions have been shown to be associated with hormonal changes in men. This paper examines the association between depression, ED, and hormonal status of men aged above 50 years in the Klang Valley, Malaysia. Methods: Five hundred men aged 50 years and above were randomly selected via the electoral roll and invited to participate in a community-based study on men's health: 351 men responded. Respondents were interviewed individually based on a self-developed questionnaire, which included information on socio-demographic data. Erectile function was measured using the International Index for Erectile Function-5 (IIEF-5) and depression was measured using the 15 item Geriatric Depression Scale (GDS-15). Results: Sixty-nine percent of the men were diagnosed with ED. Mean GDS score was 3.33 (SD = 3.29). Nineteen percent (n = 67) of the men had abnormal levels of testosterone (�11 nmol/l) and this comprised 73 of men with ED (n = 49) and 27 of men without ED (n = 18). There was no significant association between testosterone level and ED (�2 = 0.68, p = 0.41). Significant association was found between depression (GDS � 5) and men with ED (�2 = 6.07, p = 0.014). Sex hormone binding globulin and luteinising hormone were negatively correlated with erectile function. Results of the multiple linear regression showed that age and depression are predictors of erectile function. Conclusion: Depression and ED should be screened for when either exists in the male patient and treatment directed accordingly. © 2006 WPMH GmbH

Sialic acid and vascular cell adhesion molecule-l as early markers in the first degree relatives of type 2 diabetes mellitus patients

Levels of sialic acid and Vascular Cell Adhesion Molecule-I (VCAM-I)in the first degree relatives of type 2 diabetes mellitus patients and their possible role as an early marker of the prediabetic stage were studied in 74 controls and 150 first degree relatives. The total sialic acid concentration was significantly higher (p<O.05) in the first degree relatives compared to the control subjects. Amongst the offsprings, the total sialic acid concentration was significantly higher in the offspring with Normal Glucose Tolerance (NGT) than those with Impaired Glucose Tolerance (IGT). However the level of VCAM-I did not differ amongst the controls and the first degree relatives. The total cholesterol and triglycerides were significantly higher (p<0.05) in the offspring with IGT when compared to the control subjects and the offspring with NGT. The above data suggests that desialylation of the vascular endothelium is an early event that precedes the expression of IGT or any lipid changes in asymptomatic offspring of one type 2 diabetic parent

Ethnicity and glycaemic control are major determinants of diabetic dyslipidaemia in Malaysia

Aims To define the prevalence of dyslipidaemia in young diabetic patients in Peninsular Malaysia and the contributory factors of dyslipidaemia in these subjects. Methods This is a cross-sectional study involving 848 young diabetic patients from seven different centres, with representation from the three main ethnic groups. Clinical history and physical examination was done and blood taken for HbA(1c), fasting glucose, total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and triglycerides. Results The overall lipids were suboptimal, worse in Type 2 diabetes mellitus (DM) patients compared with Type 1 DM patients. Of the Type 2 patients, 73.2 had total cholesterol > 5.20 mmol/l, 90.9 had LDL-cholesterol > 2.60 mmol/l, 52.6 had HDL-cholesterol 2.30 mmol/l. There were ethnic differences in the lipid levels with the Malays having the highest total cholesterol (mean 6.19 mmol/l), and the highest LDL-cholesterol (mean 4.16 mmol/l), while the Chinese had the highest HDL-cholesterol (geometric mean 1.24 mmol/l). Ethnicity was an important determinant of total, LDL- and HDL-cholesterol in Type 2 DM, and LDL- and HDL-cholesterol and triglycerides in Type 1 DM. Glycaemic control was an important determinant of total, LDL-cholesterol and triglycerides in both Type 1 and Type 2 DM. Waist-hip ratio (WHR) was an important determinant of HDL-cholesterol and triglycerides in both types of DM. Gender was an important determinant of HDL-cholesterol in Type 2 DM, but not in Type 1 DM. Socioeconomic factors and diabetes care facilities did not have any effect on the dyslipidaemia. Conclusions The prevalence of dyslipidaemia was high especially in Type 2 DM patients. Ethnicity, glycaemic control, WHR, and gender were important determinants of dyslipidaemia in young diabetic patients

Diabetes mellitus in a Malaysian teaching hospital: prevalence of diabetes mellitus and frequency of testing for hypercholesterolaemia, proteinuria and HBA1c

We examined the prevalence of diabetes among inpatients in our hospital, the relationship of the diagnoses on admission to diabetes, and the frequency of testing for HBA1c as a marker of long-term glycaemic control, proteinuria, and hypercholesterolaemia. In addition, patients with raised laboratory plasma glucose without a known history of diabetes mellitus, were studied to see if there had been further evaluation. The overall prevalence of diabetes in our hospital was 25.3% with the highest prevalence found (37.8%) on medical wards, 10.5% of admissions were due directly to diabetes and a further 58.9% of patients were admitted with illnesses which were significantly related to diabetes. Overall testing rates for HBA1c, protenuria and hypercholesterolaemia were less than ideal (51.6, 73.4 and 45.5% respectively). Less than 50% of patients without previuosly diagnosed diabetes but with high plasma glucose values had further evaluation for diabetes. In conclusion, this study has detected a high overall prevalence of diabetes among inpatients in an urban Malaysian hospital. Rates of testing for HBA1c, proteinuria and hypercholesterolaemia, are dissapointingly low, as is further evaluation of patients without known diabetes, but with elevated glucose values. More effective measures to improve the delivery of inpatient diabetes care are needed

Serum leptin concentration in young diabetics

The objective of the study was to examine the serum leptin level in young diabetics (age of onset of diabetes <40 years old) and to determine its relationship with gender, body mass index (IBM), waist-hip ratio (WHR), type of diabetes, fasting (CF) and glucagon-stimulated C-peptide (CG). A total of 219 Type 1 (97 males, 122 females) and 423 Type 2 (216 males, 207 females) patients were recruited for the study. Blood was drawn for assays of C-peptide, leptin and glycosylated haemoglobin (HbAIc) after an overnight fast, and at 6 minutes after intravenous infusion of 1 mg glucagon for CG levels. The BMI was significantly higher in Type 2 than Type 1 diabetics (26.0±0.3 versus 22.4±0.6 kg/m2, p= 0.001). Males with Type 1 and Type 2 diabetes had significantly higher WHR compared to females. However, the serum leptin concentration was significantly higher in female subjects regardless of the type of diabetes (11.4±0.7 versus 5.4±0.5 ng/ml for Type 1 and 13.1±0.6 versus 7.8±0.4 ng/ml for Type 2) and BMI (10.7±0.7 versus 4.0±0.8 ng/ml for Type 1 diabetics and 10.8±0.6 versus 5.8±0.5 ng/ml for Type 2 diabetics with BMI _25 kglm2). Leptin concentration was positively correlated with BMI (r=0.410, p=0.0001 for Type 1; r=0.416, p=0.0001 for Type 2). The best independent predictors for serum leptin were BMI (female), age (Type 2 only ), WHR (Type 1 males and females only), CF (males only) and CG. This study confirmed that besides gender, BMI, WHR and C-peptide levels are also important factors in predicting serum leptin concentration in diabetics

Prevalence of glutamic acid decarboxylase antibodies amongst young Malaysian diabetics

This study determined the prevalence of glutamic acid decarboxylase antibodies (GAD Ab) in a group of 926 young Malaysian diabetics of three ethnic groups, Malay, Chinese, and Indian. Patients were clinically diagnosed to be Type 1 or Type 2 before the age of 40 years. The overall GAD Ab positivity was 17.4 (161/926), significantly higher in the Type 1 than the Type 2 diabetics (35.5, 116/329 vs. 7.5, 45/597, P = 0.0001). Compared to GAD Ab negative patients, seropositive diabetics were diagnosed at younger age (21.2 +/- 0.9 vs. 27.4 +/- 0.3 y, P = 0.0001), had lower fasting (289 +/- 27.4 vs. 640 +/- 17.6 pmol/l, P = 0.0001) and post-glucagon C-peptide levels (527 +/- 51.8 vs. 1030 +/- 28.9 pmol/l, P = 0.0001). There were no racial differences in the prevalence of GAD Ab; of the total Type 1, 30.8, 36.4, and 39.4 were Malay, Chinese, and Indian diabetics, respectively and of the total Type 2, 8.8, 8.2, and 4.4 were Malay, Chinese, and Indian diabetics respectively. There was a curvilinear relationship between GAD Ab and the post-glucagon C-peptide levels, suggesting that GAD Ab do play a role in the beta-cells destruction and could be an important immune marker for the LADA group. This study reconfirmed previous reports that the autoimmune mechanisms in the Type 1 Asian diabetics are indeed different from the Caucasians, and further investigations should be carried out to explain the differences. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved