scholarly journals Uric acid lowering improves insulin sensitivity and lowers blood pressure: a meta-analysis of randomized parallel-controlled clinical trials

2021 ◽  
Vol 21 (1) ◽  
pp. 82-95
Author(s):  
Qunchuan Zong ◽  
Guanyi Ma ◽  
Tao Wang

Objectives: This meta-analysis aimed to investigate whether uric acid lowering treatment can improve β-cell function and insulin sensitivity. Methods: PubMed, Cochrane Library, EMBASE and China Biology Medicine were searched up to March 1, 2020. Rand- omized controlled clinical trials of urate lowering therapy in hyperuricemia patients were included in meta-analysis. Effect size was estimated as mean difference with 95% confidence interval (CI). Results: Our search yielded 7 eligible trials with 503 participants. This meta-analysis showed that uric acid-lowering thera- py decreased fasting insulin -1.43 μIU/ml (weighted mean differences (WMD, 95% CI -2.78 to -0.09), homeostasis model assessment of insulin resistance -0.65 (WMD, 95% CI -1.05 to -0.24), systolic blood pressure -2.45 mm Hg (WMD, 95%CI -4.57 to -0.33) and diastolic blood pressure -3.41 mm Hg (WMD, 95%CI -3.87 to -2.95). However, the treatment had no significant effect on fasting plasma glucose (WMD -0.19 mmol/L, 95%CI -0.42 to 0.05), homeostasis model assessment of β-cell function index (WMD -0.02, 95%CI -0.28 to 0.24), total cholesterol (WMD 0.18 mg/dl; 95%CI, -1.39 to 1.75) and triglyceride (WMD 3.15 mg/dl, 95% CI -9.83 to 16.14). Conclusion: Uric acid-lowering therapies might improve insulin sensitivity and lower blood pressure, but had no significant effect on HOMA-β and serum lipids. Keywords: Hyperuricemia; uric acid lowering treatment; β-cell function; insulin sensitivity.

1998 ◽  
Vol 83 (2) ◽  
pp. 503-508
Author(s):  
Victor C. Pardini ◽  
Ivana M. N. Victória ◽  
Selma M. V. Rocha ◽  
Danielle G. Andrade ◽  
Aline M. Rocha ◽  
...  

Lipoatropic diabetes (LD) designates a group of syndromes characterized by diabetes mellitus with marked insulin resistance and either a localized or generalized absence of adipose tissue. In this study, we evaluated plasma leptin levels in subjects with congenital generalized lipoatropic diabetes (CGLD, n = 11) or acquired generalized lipoatropic diabetes (AGLD, n = 11), and assessed correlations between leptin levels and estimations of insulin secretion and insulin sensitivity using homeostasis model assessment (HOMA). Leptin levels were 0.86 ± 0.32, 1.76 ± 0.78, and 6.9 ± 4.4 ng/mL in subjects with CGLD, AGLD, and controls (n = 19), respectively (ANOVA P < 0.0001). Specific insulin levels were 154 ± 172, 177 ± 137 and 43 ± 22 pmol/L, respectively (P < 0.0001). Insulin sensitivity was significantly decreased in both groups with LD (P< 0.0001), whereas HOMA β-cell function was not significantly different when compared with controls. Leptin levels were significantly correlated with body mass index, insulin levels, and HOMA β-cell function, and inversely correlated with insulin sensitivity in control subjects but not in subjects with generalized LD. In conclusion, decreased leptin levels were observed in subjects with generalized LD, with a trend towards lower levels in the acquired than in the congenital form (P = 0.06). The temporal relationship between the decrease in leptin levels and the development of lipoatrophy should be investigated in at-risk young relatives of subjects with the acquired forms to assess the usefulness of leptin levels as a marker of lipoatrophy.


2019 ◽  
Vol 74 (2) ◽  
pp. 125-131 ◽  
Author(s):  
Ting Chen ◽  
Fengyun Wang ◽  
Zhenyu Chu ◽  
Ling Sun ◽  
Haitao Lv ◽  
...  

Objectives: Spexin (SPX) is a novel peptide that has recently emerged as an important regulatory adipokine of obesity and related metabolic disease. Little is known about its role in children. The aim of the current study was to determine the potential role of SPX in obese children and explore its relationships with obesity-related markers, insulin sensitivity and pancreatic β cell function. Method: We studied the levels of serum SPX in 40 obese and 32 normal weight pre-puberty children (mean age was 8.59 ± 1.82 and 8.15 ± 2.03 years in obesity and control groups respectively). We investigated the levels of body mass index, blood pressure, lipids, glucose, insulin, Homeostasis model assessment for insulin-resistant (HOMA-IR, HOMA for β-cell function [HOMA-β]), insulinogenic index and C-peptide index and analyzed their correlations with SPX levels. Results: SPX levels were significantly decreased in obese children compared to controls. Moreover, serum SPX levels were lower in IR obese subjects in contrast with the non-IR obese subjects. Serum SPX concentrations correlated negatively and significantly with triglycerides, systolic blood pressure, diastolic blood pressure, fasting insulin level, HOMA-IR, insulinogenic index, and HOMA-β levels in obese children. Conclusions: In summary, serum SPX levels significantly decreased in obese children and negatively correlated with insulin resistance and pancreatic β cell function indicators. Therefore, SPX may play a protective role in the process of glucose homeostasis and is closely related to β cell function in obese children.


2008 ◽  
Vol 99 (2) ◽  
pp. 297-302 ◽  
Author(s):  
Vinicius J. B. Martins ◽  
Paula A. Martins ◽  
Janaína das Neves ◽  
Ana L. Sawaya

Protein–energy malnutrition promotes adaptive hormonal changes that result in stunting. A previous study showed that stunted children had increased insulin sensitivity and diminished pancreatic β-cell function. The objectives of the present study were to analyse the glucose, insulin, homeostasis model assessment of insulin sensitivity (HOMA-S) and homeostasis model assessment of pancreatic β-cell function (HOMA-B) levels after nutritional recovery. The recovered group (n 62) consisted of malnourished children after treatment at a nutrition rehabilitation centre. At the beginning of treatment their age was 2·41 (sd 1·28) and 2·31 (sd 1·08) years, weight-for-age Z score − 2·09 (sd 0·94) and − 2·05 (sd 0·55) and height-for-age Z score − 1·85 (sd 1·11) and − 1·56 (sd 0·90), for boys and girls respectively. The control group consisted of well-nourished children without treatment (n 26). After treatment, boys of the recovered group gained 1·29 (sd 1·06) Z scores of height-for-age and 1·14 (sd 0·99) Z scores of weight-for-age, and girls, 1·12 (sd 0·91) and 1·21 (sd 0·74) Z scores respectively. No differences were found between control and recovered groups in insulin levels for boys (P = 0·704) and girls (P = 0·408), HOMA-B for boys (P = 0·451) and girls (P = 0·330), and HOMA-S (P = 0·765) for boys and girls (P = 0·456) respectively. The present study shows that the changes observed previously in glucose metabolism and insulin were reverted in children who received adequate treatment at nutritional rehabilitation centres and showed linear catch-up.


2011 ◽  
Vol 57 (4) ◽  
pp. 627-632 ◽  
Author(s):  
Barry R Johns ◽  
Fahim Abbasi ◽  
Gerald M Reaven

BACKGROUND Several surrogate estimates have been used to define relationships between insulin action and pancreatic β-cell function in healthy individuals. Because it is unclear how conclusions about insulin secretory function depend on specific estimates used, we evaluated the effect of different approaches to measurement of insulin action and secretion on observations of pancreatic β-cell function in individuals whose fasting plasma glucose (FPG) was <7.0 mmol/L (126 mg/dL). METHODS We determined 2 indices of insulin secretion [homeostasis model assessment of β-cell function (HOMA-β) and daylong insulin response to mixed meals], insulin action [homeostasis model assessment of insulin resistance (HOMA-IR) and steady-state plasma glucose (SSPG) concentration during the insulin suppression test], and degree of glycemia [fasting plasma glucose (FPG) and daylong glucose response to mixed meals] in 285 individuals with FPG <7.0 mmol/L. We compared the relationship between the 2 measures of insulin secretion as a function of the measures of insulin action and degree of glycemia. RESULTS Assessment of insulin secretion varied dramatically as a function of which of the 2 methods was used and which measure of insulin resistance or glycemia served as the independent variable. For example, the correlation between insulin secretion (HOMA-β) and insulin resistance varied from an r value of 0.74 (when HOMA-IR was used) to 0.22 (when SSPG concentration was used). CONCLUSIONS Conclusions about β-cell function in nondiabetic individuals depend on the measurements used to assess insulin action and insulin secretion. Viewing estimates of insulin secretion in relationship to measures of insulin resistance and/or degree of glycemia does not mean that an unequivocal measure of pancreatic β-cell function has been obtained.


Author(s):  
Manoj Kumar Mohapatra ◽  
Muralidhar Anantrao Sangle ◽  
Prafulla Kumar Bariha

Insulin Resistance is a major factor among patients with critical illness due to various causes. Severe falciparum malaria with MODS diagnosed as per the criteria of MSS and admitted to the Medical ward of our hospital were assessed for IR and β cell function by using homeostasis model assessment. 75 consecutive patients of SFM admitted to the Medical ward of our hospital were included in this study. Malaria was diagnosed as per criteria of WHO and organ dysfunction was diagnosed as per Malaria Severity Score. Insulin Resistance and β cell function was assessed by using homeostasis model assessment on Day-1 and Day-7. Out of 75 patients of severe falciparum malaria with MODS 2, 3, 4, and 5 organ dysfunctions constituted 16 (21.3%), 34 (45.3%), 16 (21.3%), and 9 (12.0%) patients, respectively.Hepatic failure was the most common organ system failure (n=58; 77.3%), followed by neurological (n=50;66.6%) ,renal (n=40;53.3%), hematological (n=30; 40.0%), and, respiratory failure ( n=15; 20.0%). Hyperglycemia was present in 25 (33.3%) cases where as normoglycemia was present in 50 (66.6%) cases. The values of FBS, Tg, insulin, IR, and β cell function decreased on Day-7 compared to Day-1 after recovery from critically ill state. The patients who died had a high insulin value, IR, but low β cell dysfunction compared to the survivors. This study showed that IR and β cell dysfunction were associated with severe malaria with MODS with increased mortality.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shixuan Liu ◽  
Tao Yuan ◽  
Shuoning Song ◽  
Shi Chen ◽  
Linjie Wang ◽  
...  

Abstract Background We aimed to investigate the clinical characteristics and islet β-cell function in patients with Klinefelter syndrome (KS) and hyperglycemia. Methods This is a retrospective study. In total, 22 patients diagnosed with KS were identified from the electronic medical record system, including 9 patients with hyperglycemia (total patients with hyperglycemia, THG-KS group) and 5 hyperglycemic KS patients with oral glucose tolerance test (OGTT) results (HG-KS group). An additional 5 subjects with hyperglycemia and 5 normal glucose tolerance (NGT) subjects matched based on body mass index were included as the HG group and NGT group, respectively. Data from clinical and laboratory examinations were collected. We further performed a literature review of KS and hyperglycemia. Results We found that KS patients developed abnormal glucose metabolism earlier in life than those without KS, and the median age was 17 years, ranging from 10 years to 19 years. Six of 17 (35.3%) patients were diagnosed with diabetes mellitus and 3 of 17 (17.6%) patients were diagnosed with prediabetes. Among 10 patients with both fasting blood glucose and insulin results recorded, there were 8 out of 17 (47.1%) KS patients had insulin resistance. The prevalence of hypertension and dyslipidemia was higher in patients with hyperglycemia and KS than in patients with NGT KS. Compared with the HG group, insulin sensitivity levels were lower in HG-KS group, whereas homeostasis model assessment of β-cell function levels (p = 0.047) were significantly, indicating higher insulin secretion levels in the HG-KS group. Conclusions KS patients develop hyperglycemia earlier in life than those without KS and show lower insulin sensitivity and higher insulin secretion. These patients also have a higher prevalence of other metabolic diseases and may have different frequencies of developing KS-related symptoms.


2015 ◽  
Author(s):  
Ελισάβετ Μουτζούρη

Εισαγωγή: Οι στατίνες διαθέτουν δράσεις, οι οποίες είναι ανεξάρτητες τηςυπολιπιδαιμικής τους δράσης. Σε αυτές συμπεριλαμβάνονται κυρίως αντιφλεγμονώδεις καιαντιοξειδωτικές δράσεις, καθώς επίσης και επιδράσεις στο μεταβολισμό τους ουρικούοξέος και στο μεταβολισμό της γλυκόζης.Σκοπός: Σκοπός αυτής της διδακτορικής διατριβής ήταν η σύγκριση των επιδράσεωνδιαφορετικών στατινών ή του συνδυασμού μιας στατίνης με την εζετιμίμπη, με τις ίδιεςυπολιπιδαιμικές δράσεις, σε παραμέτρους του οξειδωτικού stress, της φλεγμονής καθώςκαι παραμέτρους του μεταβολισμού του ουρικού οξέους και του μεταβολισμού τηςγλυκόζης σε υπερχοληστερολαιμικούς ασθενείς.Μέθοδοι: Πρωτόκολλο 1 Στη μελέτη συμμετείχαν 153 υπερχοληστερολαιμικοίασθενείς που τυχαιοποιήθηκαν σε σιμβαστατίνη 40 mg ή σε σιμβαστατίνη/εζετιμίμπη10/10 mg ή σε ροσουβαστατίνη 10 mg ημερησίως.Μετρήσαμε (πριν και μετά από 12 εβδομάδες θεραπείας):- Παραμέτρους του οξειδωτικού stress:1) 8-Epi prostaglandin F2 alpha (8-epiPGF2a)2) Oxidized LDL (oxLDL)- Παραμέτρους της φλεγμονής:1) Lipoprotein associated phospholipase A2 (Lp-PLA2) activity and mass- Παραμέτρους του μεταβολισμού της γλυκόζης:1) Homeostasis model assessment of insulin resistance (HOMA-IR)2) Ινσουλίνη νηστείας3) Γλυκόζη νηστείας4) Γλυκοζυλιωμένη αιμοσφαιρίνη (HbA1c)5) HOMA of β-cell function (HOMA-B)- Παραμέτρους του μεταβολισμού του ουρικού οξέους:1) Επίπεδα του ουρικού οξέος,2) Κλασματική απέκκριση του ουρικού οξέοςΠρωτόκολλο 2: Στη μελέτη συμμετείχαν 60 ασθενείς που τυχαιοποιήθηκαν σεσιμβαστατίνη 40 mg ή σε σιμβαστατίνη/εζετιμίμπη 10/10 mg ημερησίως.Μετρήσαμε (πριν και μετά από 12 εβδομάδες θεραπείας):1) Τη μεμβρανική έκφραση των TLR2 και TLR4 σε περιφερικά μονοκύτταρα,2) Την επαγώμενη από λιποπολυσακχαρίτη ενδοκυττάρια έκκριση των ιντερλευκινών1β και 6.Αποτελέσματα: Πρωτόκολλο 1: Παρατηρήθηκε μια σημαντική μείωση στα επίπεδαπλάσματος των 8-ισοπροστανίων και της oxLDL σε όλες τις ομάδες [10%, 8% και 6% (p <0.05 σε σύγκριση με τις αρχικές τιμές) και 41%, 40% και 39% (p < 0.001 σε σύγκριση με τιςαρχικές τιμές) για την ομάδα της σιμβαστατίνης, σιμβαστατίνης/εζετιμίμπης καιροσουβαστατίνης, αντίστοιχα]. Σε όλες τις ομάδες παρατηρήθηκε μια σημαντική μείωσητης μάζας και ενεργότητας της Lp-PLA2 (36%, 31% και 38% και 36%, 32% και 32% για τηνομάδα της σιμβαστατίνης, σιμβαστατίνης/εζετιμίμπης και ροσουβαστατίνης, αντίστοιχα, p< 0.001 σε σύγκριση με τις αρχικές τιμές). Δεν παρατηρήθηκαν διαφορές ανάμεσα στιςομάδες.Και οι 3 θεραπείες σχετίστηκαν με σημαντική αύξηση του δείκτη HOMA-IR και τωνεπιπέδων ινσουλίνης νηστείας (p < 0.05 σε σύγκριση με τις αρχικές τιμές). Δενπαρατηρήθηκαν διαφορές ανάμεσα στις ομάδες. Δεν σημειώθηκαν αλλαγές στα επίπεδατης γλυκόζης νηστείας, της HbA1c και του δείκτη HOMA-Β.Σημαντική μείωση των επιπέδων του ουρικού οξέος παρατηρήθηκε σε όλες τιςομάδες (σιμβαστατίνη 40 mg: -5.7%, σιμβαστατίνη/εζετιμίμπη 10/10 mg: -3.8% καιροσουβαστατίνη 10 mg: -3.8%; p<0.05 σε σύγκριση με τις αρχικές τιμές, p=NS για τησύγκριση ανάμεσα στις 3 θεραπευτικές ομάδες). Η κλασματική έκκριση του ουρικού οξέοςαυξήθηκε, ωστόσο στατιστικά μη σημαντικά, σε όλες τις ομάδες (σιμβαστατίνη/εζετιμίμπη10/10 mg: +6.8%, σιμβαστατίνη 40 mg: +6.8% και ροσουβαστατίνη 10 mg: +5.9%). Ημείωση των επιπέδων του ουρικού οξέος συσχετιζόταν με τη με την αύξηση τηςκλασματικής απέκκρισης του ουρικού οξέος. Οι παράμετροι της νεφρικής λειτουργίαςπαρέμειναν αμετάβλητοι σε όλες τις ομάδες.Πρωτόκολλο 2: Οι υπερχοληστερολαιμικοί ασθενείς είχαν υψηλότερα επίπεδα μεμβρανικής έκφρασης TLR2 και TLR4 σε σύγκριση με την ομάδα ελέγχου (p < 0.02). Τόσο ηθεραπεία με σιμβαστατίνη όσο και η θεραπεία με το συνδυασμόσιμβαστατίνης/εζετιμίμπης οδήγησαν σε σημαντική μείωση της έκφρασης των TLR2 και 4 (p< 0.01 σε σύγκριση με τις αρχικές τιμές), χωρίς διαφορές ανάμεσα στις 2 ομάδες. Επιπλέονκαι οι 2 θεραπείες οδήγησαν σε συγκρίσιμες μειώσεις των επιπέδων έκφρασης της LPS-επαγώμενης ιντερλευκίνης-1β και IL-6 (p < 0.05 σε σύγκριση με τις αρχικές τιμές).Συμπεράσματα: Πρωτόκολλο 1: Η σιμβαστατίνη 40 mg, ο συνδυασμόςσιμβαστατίνης/εζετιμίμπης 10/10 mg και η ροσουβαστατίνη 10 mg μειώνουν σημαντικά ταεπίπεδα των 8-ισοπροστανίων, της oxLDL καθώς και τη μάζα και ενεργότητα της Lp-PLA2 σεπαρόμοιο βαθμό.Οι 3 παραπάνω θεραπείες δε διαφέρουν ως προς τις δράσεις τους στο μεταβολισμότης γλυκόζης.Η σιμβαστατίνη 40 mg, ο συνδυασμός σιμβαστατίνης/εζετιμίμπης 10/10 mg και ηροσουβαστατίνη 10 mg μειώνουν συγκρίσιμα τα επίπεδα του ουρικού οξέος.Πρωτόκολλο 2: Η σιμβαστατίνη 40 mg σε σύγκριση με το συνδυασμό σιμβαστατίνηςμε εζετιμίμπη 10/10 mg μείωσαν παρόμοια τα επίπεδα μεμβρανικής έκφρασης των TLR2,TLR4 και την LPS-επαγώμενη ενδοκυττάρια παραγωγή ιντερλευκίνης -1β και -6 σεπεριφερικά μονοκύτταρα υπερχοληστερολαιμικών ασθενών.


2021 ◽  
Vol 23 (3) ◽  
pp. 116-123
Author(s):  
Mehdi Rostamizadeh ◽  
Alireza Elmieh ◽  
Farhad Rahmani Nia

Background and aims: Many findings have shown the potential relation between osteocalcin (OCN) and regulating energy metabolism. In addition, it has been revealed that physical activity increases OCN levels. Therefore, the present study aimed to investigate the effects of different exercise trainings on β-cell function, insulin resistance, and OCN levels in overweight men. Methods: In this study, 33 overweight, young men [Body mass index (BMI): 29.32±0.75 and age range of 31.50±2.23] were randomly divided into control (n=11), aerobic exercise (n=11), and resistance exercise (n=11) groups. Participants of the exercise group were on the 8-week supervised exercise training program for three sessions per week. Weight, body fat percentage, and BMI were analyzed, and then OCN, insulin, and the homeostasis model assessment of insulin resistance (HOMA-IR) were assessed from fasting blood samples before and after the 8-week exercise program. Finally, data were analyzed by t test and analysis of covariance (ANCOVA). Results: Based on the results, BMI and body weight, insulin, glucose, and HOMA-IR reduced following the exercise (P<0.05) whereas serum OCN significantly increased in aerobic exercise (P=0.001) and resistance exercise (P=0.000) groups. There were no significant changes in β-cell function in aerobic exercise (P=0.512) and resistance exercise (P=0.16) groups. Pearson correlation analysis demonstrated that OCN levels were not correlated with HOMA-IR (P=0.743) and insulin levels (P=0.143). However, OCN was positively associated with the homeostasis model assessment of b-cell function (P=0.014) and glucose (P=0.025). Conclusion: The results of the present study confirmed that aerobic and resistance exercises cause some changes in body weight and BMI, as well as the OCN and HOMA-IR. Nonetheless, changes in OCN levels were not predictors of changes in insulin secretion from pancreatic beta cells.


2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Hang Guo ◽  
Chunlei Ma ◽  
Xiaoming Wu ◽  
Congqing Pan

Objective. To investigate the functional status of pancreatic α and β cells in Type 2 diabetes mellitus (T2DM) patients with different plasma triglyceride (TG) levels. TG levels can be prognostic markers for T2DM. Methods. A total of 328 patients with T2DM were divided into three groups according to different TG levels: the TGL group: TG < 1.7 mmol/L; TGM group: 1.7 mmol/L ≤ TG < 2.3 mmol/L; and TGH group: TG ≥ 2.3 mmol/L. An oral glucose tolerance test (OGTT), insulin release test, and glucagon release test were performed in each patient. The changes of glucagon, glucagon/insulin ratio, early insulin secretion index ( Δ I 30 / Δ G 30 ), and area under the insulin curve (AUCI) were compared among each group. Also, the correlations between glucagon and pancreatic β-cell function, glycosylated hemoglobin (HbA1c), and other indices were analyzed. Results. With the increase of TG, the fasting and postprandial glucagon levels, the glucagon/insulin ratio, and the area under the glucagon curve (AUCG) presented an increasing trend. The homeostasis model assessment of insulin resistance (HOMA–IR) of the TGH group was significantly increased compared to the TGL and TGM groups. In addition to the increase in TG levels, the insulin sensitivity index (ISI), homeostasis model assessment for β-cell function index (HOMA-β), Δ I 30 / Δ G 30 , and AUCI displayed a reducing trend. Glucagon was negatively correlated with Δ I 30 / Δ G 30 , high-density lipoprotein (HDL), HOMA-β, body mass index (BMI), ISI, and AUCI ( P < 0.05 ) and positively correlated with fasting blood glucose (FPG), AUCG, HOMA-IR, HbA1c, duration, TG, low-density lipoprotein (LDL), and total cholesterol (TC) ( P < 0.05 ). Conclusion. Hypertriglyceridemia aggravated the dysfunction of pancreatic α and β cells. A reasonable control of the TG level makes it easier for blood glucose to reach the standard.


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