The Story of Homa

The following short story is in dedication to all the women who have been denied an education because of their gender

The effect of atorvastatin on pancreatic beta cell requirement in women with polycystic ovary syndrome

Background There is an increased risk of developing T2DM in women with polycystic ovary syndrome (PCOS) and there is evidence that statins improve metabolic parameters in these patients. However, there is some data to show that statins increase the risk of incipient diabetes. Material and Methods We have previously shown that 12-weeks of atorvastatin improves insulin resistance when measured using HOMA-IR. This post hoc-analysis was designed to look at the effect of atorvastatin on pancreatic β cell function using HOMA-β in the same study. In this randomised, double blind placebo controlled study, 40 medication naïve patients with PCOS were randomized to either atorvastatin 20 mg daily or placebo for 3 months. A 3-month extension study for both groups of patients was undertaken with metformin 1500 mg daily after completing initial 3 months of atorvastatin or placebo. Results There was a significant reduction in HOMA-β (240±3.2vs.177±2.3; pvalue<0.01) after 12 weeks of atorvastatin treatment which was maintained by metformin in the subsequent 12 weeks. There were no changes in HOMA-β after the placebo or after subsequent metformin treatment. There was no linear correlation between reduction in HOMA-β with improvement of free androgen index (FAI) (r2=0.02;p=0.72), testosterone (r2=0.13;p=0.49), SHBG (r2=0.22;p=0.48), hsCRP (r2=0.19;p=0.64), triglycerides (r2=0.09;p=0.12), total cholesterol (r2=0.11;p=0.32) or LDL-C (r2=0.19;p=0.38). Conclusion Treatment with atorvastatin for 12 weeks in women with PCOS significantly reduced HOMA-β. This could be potentially due to fall in βcell requirement with improvement of insulin resistance rather than a reduction of βcell function

Renin-Angiotensin-Aldosterone System, Glucose Metabolism and Incident Type 2 Diabetes Mellitus: MESA.

Background Mechanistic studies suggest that aldosterone impairs glucose metabolism. We investigated the cross-sectional associations of aldosterone and plasma renin activity with fasting plasma glucose, insulin resistance ( IR ), β-cell function, and longitudinal association with incident diabetes mellitus among adults in MESA (the multiethnic study of atherosclerosis) prospective cohort study. Methods and Results Homeostatic model assessment of IR ( HOMA 2- IR ) and HOMA 2-β were used to estimate IR and β-cell function, respectively. Incident diabetes mellitus was defined as fasting plasma glucose ≥126 mg/dL or anti-diabetic medication use at follow-up. Linear regression was used to examine cross-sectional associations of aldosterone with fasting plasma glucose, HOMA 2- IR and HOMA 2-β; Cox regression was used to estimate hazard ratios ( HR ) for incident diabetes mellitus with multivariable adjustment. There were 116 cases of incident diabetes mellitus over 10.5 years among 1570 adults (44% non-Hispanic white, 13% Chinese American, 19% Black, 24% Hispanic American, mean age 64±10 years, 51% female). A 100% increase in log-aldosterone was associated with a 2.6 mg/dL higher fasting plasma glucose, 15% higher HOMA 2- IR and 6% higher HOMA 2-β ( P<0.01). A 1- SD increase in log-aldosterone was associated with a 44% higher risk of incident diabetes mellitus ( P<0.01) with the greatest increase of 142% ( P<0.01) observed in Chinese Americans ( P for interaction=0.09 versus other ethnicities). Similar cross-sectional findings for log-plasma renin activity existed, but log-plasma renin activity was not associated with incident diabetes mellitus after full adjustment. Conclusions Aldosterone is associated with glucose homeostasis and diabetes mellitus risk with graded associations among Chinese Americans and blacks, suggesting that pleiotropic effects of aldosterone may represent a modifiable mechanism in diabetes mellitus pathogenesis with potential racial/ethnic variation

Inequality of Happiness: Evidence of the Compression of the Subjective-Well-Being Distribution with Economic Growth

The use of Subjective Wellbeing (SWB) measures in economics research has grown markedly (Kahneman and Krueger 2006). This has come about for at least two reasons. First, the measures have been systematically validated as reliable for examining a range of questions. Second, economists have long relied on income as a proxy for wellbeing. However, research shows that there are potentially large slippages between economic indicators and wellbeing (Diener and Seligman 2004). Thus, SWB measures have become an important alternative proxy for wellbeing. Indeed, SWB measures have also caught the attention of policy makers. The OECD launched the Better Life Index in 2011 as an alternative wellbeing measure; and the former French President Nicolas Sarkozy formed the Stiglitz Commission in 2008 to identify the limits of gross domestic product (GDP) as a measure of wellbeing and to identify alternative measures (Stiglitz, Sen, and Fitoussi 2010). When studying the distribution of income, economists have long recognized the importance of examining measures of central tendency and dispersion, as the latter are necessary to understand income inequality and poverty (Stiglitz, Sen, and Fitoussi 2010). Thus, there is a vast literature analyzing both the first and second moments of the distribution of income. For example, the Lorenz and Kuznets curves try to model the distribution of income, and the Gini coefficient summarizes the entire distribution in a scalar (see Atkinson 1970; Gastwirth 1972; Gini 1921; Gottschalk and Smeeding 1887; Kuznets 1955; and Lorenz 1905). In contrast, the vast majority of SWB research focuses on mean SWB. Given the current interest in SWB measures, and recognizing that the entire distribution of SWB merits study, we believe it is important to study SWB inequality (dispersion) as well as mean SWB. In this paper, we contribute to the emerging SWB literature by investigating the relationship between economic growth and SWB inequality using data from the World Values Survey (WVS) and the World Bank’s World Development Indicators (WDI). The results suggest that economic growth is inversely related to SWB inequality in cross-sectional analysis. There is also some evidence from time-series analysis that countries that experience greater economic growth rates also experience the greater decreases in SWB inequality, although this pattern does not hold for two of the fastest growing countries in the dataset. This is important because it indicates that economic growth may reduce SWB inequality over time, even if it does not increase mean SWB. The paper proceeds as follows. Section II reviews the related literature. Section III describes the data. Section IV presents the results. Section V concludes

Impaired Insulin sensitivity and Insulin secretion in Haemodialysis patients with and without Secondary Hyperparathyroidism

The aim of our study was to investigate insulin sensitivity and beta cell function in hemodialysis (HD) patients without diabetes. We hypothesized that parathyroid gland function was a determinant of insulin sensitivity and/or beta cell function. The study was a randomized, cross-sectional one and patients were divided into two groups (total 27 patients), Gp.1 being those with relative hypoparathyroidism (iPTH<200 pg/ml) ­ 9 (33.3%), Gp.2 those with hyperparathyroidism (iPTH200 pg/ml) ­ 18 (66.6%) with Gp.3 (consisting of 43 healthy subjects acting as controls). Insulin resistance and insulin secretion were calculated from fasting serum insulin and glucose concentrations by the Homeostatic Model Assessment score (HOMA IR and HOMA BETA). The value of HOMA IR (3.28±1.3 for Gp.1, 4.80±2.4 for Gp.2, 1.70±0.8 for Gp.3) as well as the glucose level (5.0±1.0mmol/l in Gp.1, 5.2±0.8mmol/ l in Gp.2, 4.6±0.4mmol/l in Gp.3) was significantly higher in HD patients than in control subjects. Excessive insulin secretion was present in HD patients (as assessed by HOMA BETA) significantly higher only in Gp.1 (p=0.02).peer-reviewe