4 research outputs found
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Acanthosis Nigricans across the spectrum of insulin resistance: A study in a tri-ethnic population at risk for glucose intolerance
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C-reactive protein is elevated in obese patients with the metabolic syndrome
C-reactive protein (CRP) is associated with increased risk for cardiovascular disease and diabetes. Few studies have evaluated the importance of CRP in those with the cluster of cardiovascular risk factors known as the metabolic syndrome (MS). We studied 190 overweight subjects (83 men and 107 women), aged 25–75 years, screened for glucose intolerance, in order to assess whether CRP levels vary according to the presence of MS, and to examine the relationship between CRP levels and metabolic variables. The prevalence of the Adult Treatment Panel III MS was 36.8%. Subjects with the MS had a higher degree of insulin resistance (IR), measured by the homeostasis model assessment (HOMA) method (5.4±0.4 versus 3.6±0.3,p3mg/dl) (OR=3.1, 95% C.I.: 1.4–10.1), followed by female gender and smoking. These results confirm that CRP levels are elevated in MS subjects at risk for glucose intolerance. In addition waist circumference, HOMAIR and FFA levels are associated with CRP levels, suggesting potential roles of obesity, insulin resistance and lipolysis in the development of the subclinical inflammation associated with the MS
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Increased apolipoprotein C-III levels associated with insulin resistance contribute to dyslipidemia in normoglycemic and diabetic subjects from a triethnic population
Despite the major role of insulin in regulating apolipoprotein C-III (apo C-III) production, little is known about the relationship between apo C-III and insulin resistance. We examined this relationship, and the association of apo C-III with dyslipidemia, in a triethnic sample of 168 subjects with normoglycemia or type 2 diabetes. African-Americans had lower triglycerides (1.21
±
0.11
mmol/l) compared with Hispanics (2.01
±
0.14
mmol/l) and white non-Hispanics (1.83
±
0.15
mmol/l), regardless of gender and type 2 diabetes status (
P
<
0.01), but this difference was partially accounted for by ethnic difference in apo C-III levels. Metabolic syndrome was associated with high apo C-III (>14
mg/dl) in Hispanics (OR
=
5.6; 95%CI: 1.3–23.4) and white non-Hispanics (OR
=
6.9; 95%CI: 1.3–36.4), but not in African-Americans. Apo C-III was the best predictor of triglycerides (
R
2
=
0.54,
P
<
0.001), after accounting for demographic and clinical variables. We found an inverse relationship between apo C-III levels and low-density lipoprotein (LDL) particle size in the type 2 diabetes subjects with (
r
=
−0.36,
P
=
0.02) and without (
r
=
−0.47,
P
=
0.02) the metabolic syndrome, but in normoglycemic subjects an inverse relationship was evident only in metabolic syndrome subjects (
r
=
−0.52,
P
<
0.01). These results suggest that higher apo C-III may contribute to the increased cardiovascular risk in subjects with insulin resistance and type 2 diabetes through its effects on triglycerides and LDL particle size
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Effect of Metformin and Lifestyle Interventions on Mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study
ObjectiveTo determine whether metformin or lifestyle modification can lower rates of all-cause and cause-specific mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study.Research design and methodsFrom 1996 to 1999, 3,234 adults at high risk for type 2 diabetes were randomized to an intensive lifestyle intervention, masked metformin, or placebo. Placebo and lifestyle interventions stopped in 2001, and a modified lifestyle program was offered to everyone, but unmasked study metformin continued in those originally randomized. Causes of deaths through 31 December 2018 were adjudicated by blinded reviews. All-cause and cause-specific mortality hazard ratios (HRs) were estimated from Cox proportional hazards regression models and Fine-Gray models, respectively.ResultsOver a median of 21 years (interquartile range 20-21), 453 participants died. Cancer was the leading cause of death (n = 170), followed by cardiovascular disease (n = 131). Compared with placebo, metformin did not influence mortality from all causes (HR 0.99 [95% CI 0.79, 1.25]), cancer (HR 1.04 [95% CI 0.72, 1.52]), or cardiovascular disease (HR 1.08 [95% CI 0.70, 1.66]). Similarly, lifestyle modification did not impact all-cause (HR 1.02 [95% CI 0.81, 1.28]), cancer (HR 1.07 [95% CI 0.74, 1.55]), or cardiovascular disease (HR 1.18 [95% CI 0.77, 1.81]) mortality. Analyses adjusted for diabetes status and duration, BMI, cumulative glycemic exposure, and cardiovascular risks yielded results similar to those for all-cause mortality.ConclusionsCancer was the leading cause of mortality among adults at high risk for type 2 diabetes. Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates