Trace elements in glucometabolic disorders: an update

Many trace elements, among which metals, are indispensable for proper functioning of a myriad of biochemical reactions, more particularly as enzyme cofactors. This is particularly true for the vast set of processes involved in regulation of glucose homeostasis, being it in glucose metabolism itself or in hormonal control, especially insulin. The role and importance of trace elements such as chromium, zinc, selenium, lithium and vanadium are much less evident and subjected to chronic debate. This review updates our actual knowledge concerning these five trace elements. A careful survey of the literature shows that while theoretical postulates from some key roles of these elements had led to real hopes for therapy of insulin resistance and diabetes, the limited experience based on available data indicates that beneficial effects and use of most of them are subjected to caution, given the narrow window between safe and unsafe doses. Clear therapeutic benefit in these pathologies is presently doubtful but some data indicate that these metals may have a clinical interest in patients presenting deficiencies in individual metal levels. The same holds true for an association of some trace elements such as chromium or zinc with oral antidiabetics. However, this area is essentially unexplored in adequate clinical trials, which are worth being performed

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Effect of vanadium on insulin sensitivity in patients with impaired glucose tolerance

Background/Aim: Impaired glucose tolerance (IGT) is considered a risk factor for developing type 2 diabetes mellitus (T2DM) and is associated with insulin resistance. Vanadium seems to block protein tyrosine phosphatase with the consequent increment in insulin sensitivity (INS) in T2DM patients, but this effect has not been studied in IGT patients. The aim of this study was to evaluate the effect of vanadium on INS in IGT patients. Methods: A randomized, double-blind, placebo-controlled clinical trial was carried out in 14 overweight/obese patients with IGT. Intervention consisted of vanadyl sulfate (VS, 50 mg p.o. twice daily) or placebo for 4 weeks. Before and after the intervention, a metabolic profile was performed and INS was assessed using the euglycemic-hyperinsulinemic clamp technique. Mann-Whitney U and Wilcoxon rank tests were used for statistical analyses. Results: There were no significant differences in basal characteristics between groups. VS did not affect INS [2.7 Zapotitlán 0.8 vs. 2.9 Zapotitlán 0.9 mg/(kg/min), p = 0.735] but increased triglyceride levels (1.35 Zapotitlán 0.61 vs. 1.70 Zapotitlán 0.46 mmol/l, p = 0.018). Conclusions: VS administration in IGT patients increased triglyceride concentrations without changes in INS. Copyright Zapotitlán 2008 S. Karger AG

The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp

Context: To meet the worldwide challenge of emerging diabetes, accessible and inexpensive tests to identify insulin resistance are needed. Objective: To evaluate the sensitivity and specificity of the product of fasting, we compared the triglycerides and glucose (TyG) index, a simple measure of insulin resistance, with the euglycemichyperinsulinemic clamp test. Design and Setting: We conducted a cross-sectional study of the general population and outpatients of the Internal Medicine Department at the Medical Unit of High Specialty of the Specialty Hospital at the West National Medical Center in Guadalajara, Mexico. Patients: Eleven nonobese healthy subjects, 34 obese normal glucose tolerance individuals, 22 subjects with prediabetes, and 32 diabetic patients participated in the study. Intervention: We performed a euglycemic-hyperinsulinemic clamp test. Main Outcome Measures: Sensitivity and specificity of the TyG index [Ln(fasting triglycerides) (mg/dl) x fasting glucose (mg/dl)/2] were measured, as well as the area under the curve of the receiver operating characteristic scatter plot and the correlation between the TyG index and the total glucose metabolism (M) rates. Results: Pearson's correlation coefficient between the TyG index and M rates was -0.681 (P < 0.005). Correlation between the TyG index and M rates was similar between men (-0.740) and women (-0.730), nonobese (-0.705) and obese (-0.710), and nondiabetic (-0.670) and diabetic (-0.690) individuals. The best value of the TyG index for diagnosis of insulin resistance was 4.68, which showed the highest sensitivity (96.5%) and specificity (85.0%; area under the curve + 0.858). Conclusions: The TyG index has high sensitivity and specificity, suggesting that it could be useful for identification of subjects with decreased insulin sensitivity. Copyright © 2010 by The Endocrine Society

La geografía y la economía en sus vínculos actuales : una antología comentada del debate contemporáneo

Desde hace décadas, La Geografía y la Economía han forjado un espacio de discusión que debate sobre las intersecciones dadas entre ambas disciplinas. A raíz del surgimiento de la llamada Nueva Geografía Económica, asociada al laureado Premio Nobel de Economía, Paul Krugman, ha surgido un intenso debate acerca de los vínculos entre estas dos ramas del conocimiento y de su relevancia para las Ciencias Sociales de hoy en día. A su vez, dicho debate se ha visto enriquecido con el avance metodológico que tanto la Geografía como la Economía han experimentado en años recientes, para estudiar analítica y empíricamente diversos procesos regionales