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L-CARNITINE ADMINISTRATION IMPROVES INSULIN SENSITIVITY IN PATIENTS WITH IMPAIRED GLUCOSE METABOLISM
S48
Oral Communications / European Journal of Internal Medicine 19S (2008), S1–S59
SA-04 L-CARNITINE ADMINISTRATION IMPROVES INSULIN SENSITIVITY IN PATIENTS WITH IMPAIRED GLUCOSE METABOLISM A. Molfino, A. Cascino, C. Ramaccini, C. Conte, F. Rossi Fanelli, A. Laviano. Department Clinical Medicine, Sapienza – University of Rome, Italy. Rationale: Insulin resistance and type II diabetes are characterized by hyperglycemia and hyperinsulinemia. Insulin resistance may be associated with mitochondrial dysfunction. L-carnitine, an intramitochondrial carrier of acylic groups, is a molecule involved in lipids and carbohydrates metabolism. Lcarnitine therefore may modulate cell energy metabolism. We designed a study to investigate the effects of oral L-carnitine administration on plasma glycemic and insulinemic profile in patients with impaired fasting glucose or diabetes mellitus type II. Methods: The effect of L-carnitine was investigated in 16 patients (12 males and 4 females); the mean age ± SD was 66.69±13.37 y. Patients were randomly assigned to two groups. The first group (LC, n=8; 5 M and 3 F) received L-carnitine (4 grams/day) and 1200 or 1400 Kcal/day standard diet for women or men respectively, for 10 consecutive days. The second group (C, n=8; 7 M and 1 F) received only 1200 or 1400 Kcal/day standard diet for women or men respectively, for 10 consecutive days. Oral glucose tolerance test (OGTT, basal and 2 hours), fasting plasma insulin levels and Homeostasis Model Assessment (HOMA-IR) were assessed in each group before and after treatment. Results: Fasting plasma glucose levels were not statistically different in the two groups after treatment. OGTT-2 hours significantly improved after treatment both in LC (232.62±64.75 mg/dl vs 146.25±59.04 mg/dl, p=0.015) and C group (193.25±64.11 mg/dl vs 128±53.29 mg/dl, p=0.04). Interestingly, we observed a significant improvement in plasma insulin levels and HOMA-IR after treatment in LC group (7.04±2.6 µU/ml vs 4.51±1.79 µU/ml, p=0.04; 1.95±0.79 vs 1.17±0.51, p=0.03). No significant differences in plasma insulin levels and HOMA-IR were observed in C group. Conlcusions: L-carnitine in association with low calorie diet significantly ameliorates OGTT-2 hours, reduces plasma insulin levels and diminishes insulin resistance, as indicated by HOMA-IR improvement.
SA-05 THE MOTILITY OF THE ESOPHAGEAL BODY: COMPARISON BETWEEN TYPE 2 DIABETICS PATIENTS AND HEALTHY INDIVIDUALS J.X. Jorge, A. Coelho, E.A. Panão, C. Simões, C.C Almeida. Instituto de Fisiologia, Fac. Medicina da Univ. de Coimbra, Serviço de Medicina e Gastrenterol, CHC Introduction: The influence of diabetes Mellitus on the esophageal motility is not well known. Some studies has diferents results.The aim of this study was to compare some motor caracteristics of the esophageal body between type 2 diabetics patients and healthy individuals. Material and Methods: A stationary esophageal manometry with 6 channels catheter has been made in 14 adults type 2 diabetics (11 males and 3 females) of mean age 54,8 years old (45-72), and 16 non diabetics healthy, 11 males and 5 females of mean age 60,2 years old (31-81). Results: In the diabetic group the waves registed was: 83,9% peristaltics, 4,4% simultaneas, 9% non transmited and 3,2% retrograds. However in the healthy group the regist was:86,2% peristaltics, 3,8% simultaneas, 14,9% non transmited and 0,56% retrograds. The percentage of diabetics patients with anormal waves up normal was: 7,1% with simultaneas, 14,3% with non transmited and 42% with retrograds waves. Between the non diabetics it was:0% with simultaneas, 18,7% with non transmited and 18% with retrograds waves. Conclusion: The anormal esophageal waves were more frequents in diabetic pacients than in healthy individuals. Particularly, the retrograd waves was significatively more frequent in type 2 diabetics patients.
SA-06 THE ASSOCIATION OF IRON STORES AND DIABETES MELLITUS TYPE II Patiakas Stefanos, Eirini Vasileiou, Vardakis Zaharias, Tsoukis Evangelos. Microbiology/Biochemistry Department of General Hospital of Gumenissa Aim: The evaluation and comparison of iron stores in patients with Diabetes Mellitus type II as well as in healthy individuals Methods: During the year 2005, 200 patients, with Diabetes Mellitus, were
examined into the General Hospital of Gumenissa, (82 men and 118 women, 57-78 years old) and 100 healthy people (42 men and 58 women, at the same age) as reference group. In both cases, HbA1c and ferritin levels were evaluated in plasma, while other causes of high ferritin levels were excluded. We used ADAMS HA-8160 and ACESS). Results: Patients with Diabetes Mellitus type II had statistically significant higher levels of ferritin comparing to the reference group (104.92±83.8, vs. 75.8±47), p<0.05. Conclusions: Patients with Diabetes Mellitus type II, had significantly higher ferritin levels comparing to healthy population, a fact that argues in favor of hemochromatosis having increased impact in Diabetes Mellitus. Small increases of Fe has been supported to contribute into the production of free radicals of Oxygen and thus to the insulin resistance. Possibly, in the future the reduction of iron stores could be an additional factor contributing in Diabetes Mellitus prevention.
SA-07 METABOLIC SYNDROME PER SE SIGNIFICANTLY INCREASES TARGET ORGAN DAMAGE IN SUBJECTS WITHOUT OVERT CARDIOVASCULAR RISK FACTORS Davide Grassi, Cristina Lippi, Stefano Necozione, Monica Michetti, Azzurra D’Aurelio, Luisa Petrazzi, Lorella Polidoro, Giuliana Properzi, Giovambattista Desideri, Claudio Ferri. Department of Internal Medicine and Public Health, University of L’Aquila Objectives: Metabolic syndrome (MS) often associated with hypertension markedly increases cardiovascular risk. Target organ damage (TOD) is more common in hypertensives with than without MS. Whether MS per se, without overt cardiovascular risk (OCVR) is associated with an increased expression of TOD is yet controversial. The current study investigated the prevalence of TOD in subjects with MS but no OCVR. Methods: MS was defined according to ATP III criteria. Considering presence or absence of hypertension as OCVR, we divided the patients in two groups (I= MS + hypertension and II= MS without OCVR), an healthy group was considered for control. Each participant was submitted to echocardiography, carotid ultrasonography, 24 h urine collection and blood pressure (BP) measures. Results: 158 subjects (26.8%) had MS. 41.1% of these were without OCVR. Group I presented with higher BP levels than group II (p<.05). Prevalence of microalbuminuria and increased IMT (83.8 vs 75.3% and 21.5 vs 18.4%, respectively) was not statistically different, while prevalence of LVH (29.0 vs 6.1%, respectively), was significantly higher (p <.001) in I respect to II group. Compared to II and control groups, group I showed higher albuminuria, LVMI and IMT (p<.05). Group II showed higher albuminuria respect to controls (35.7±10.7 vs 20.7±5.3 mg/24h, respectively, p<.05). Insulin resistance was significantly (p<.05) higher in I and II respect to control group. In the population studied, multivariate analysis indicated impaired fasting glucose as independent risk factor for microalbuminuria, obesity for impaired IMT and high diastolic BP levels for microalbuminuria and LVH. Conclusion: Our study suggested that: 1) MS per se leads to TOD and combined hypertension entails additional CVR in this population; 2) Presence of TOD should be researched in apparently healthy subjects presenting with MS; 3) Lifestyle changes and/or combined drug therapy should be eventually considered in all subjects with MS.
Saturday, 10 May 2008, 9.45–11.15
Room B
Clinical Cases SA-08 CUTANEOUS, ARTICULAR, PULMONARY AND GASTROINTESTINAL SARCOIDOSIS – UNUSUAL FORM OF SYSTEMIC PRESENTATION Andrea Mateus, Arlindo Guimas, João Correia, Abilio Reis, Nelson Rocha. Hospital Geral Santo António - Medicina 1 Sarcoidosis is a systemic disease of unknown etiology. The diagnosis is based on suggestive clinical and radiological findings and by the presence of noncaseating granulomas at sites of disease involvement. Many atypical presentations of Sarcoidosis have been described. Distintion between Sarcoidosis and Tuberculosis is not easy because of the many clinical and histological features they share.
Oral Communications / European Journal of Internal Medicine 19S (2008), S1–S59
SA-04 L-CARNITINE ADMINISTRATION IMPROVES INSULIN SENSITIVITY IN PATIENTS WITH IMPAIRED GLUCOSE METABOLISM A. Molfino, A. Cascino, C. Ramaccini, C. Conte, F. Rossi Fanelli, A. Laviano. Department Clinical Medicine, Sapienza – University of Rome, Italy. Rationale: Insulin resistance and type II diabetes are characterized by hyperglycemia and hyperinsulinemia. Insulin resistance may be associated with mitochondrial dysfunction. L-carnitine, an intramitochondrial carrier of acylic groups, is a molecule involved in lipids and carbohydrates metabolism. Lcarnitine therefore may modulate cell energy metabolism. We designed a study to investigate the effects of oral L-carnitine administration on plasma glycemic and insulinemic profile in patients with impaired fasting glucose or diabetes mellitus type II. Methods: The effect of L-carnitine was investigated in 16 patients (12 males and 4 females); the mean age ± SD was 66.69±13.37 y. Patients were randomly assigned to two groups. The first group (LC, n=8; 5 M and 3 F) received L-carnitine (4 grams/day) and 1200 or 1400 Kcal/day standard diet for women or men respectively, for 10 consecutive days. The second group (C, n=8; 7 M and 1 F) received only 1200 or 1400 Kcal/day standard diet for women or men respectively, for 10 consecutive days. Oral glucose tolerance test (OGTT, basal and 2 hours), fasting plasma insulin levels and Homeostasis Model Assessment (HOMA-IR) were assessed in each group before and after treatment. Results: Fasting plasma glucose levels were not statistically different in the two groups after treatment. OGTT-2 hours significantly improved after treatment both in LC (232.62±64.75 mg/dl vs 146.25±59.04 mg/dl, p=0.015) and C group (193.25±64.11 mg/dl vs 128±53.29 mg/dl, p=0.04). Interestingly, we observed a significant improvement in plasma insulin levels and HOMA-IR after treatment in LC group (7.04±2.6 µU/ml vs 4.51±1.79 µU/ml, p=0.04; 1.95±0.79 vs 1.17±0.51, p=0.03). No significant differences in plasma insulin levels and HOMA-IR were observed in C group. Conlcusions: L-carnitine in association with low calorie diet significantly ameliorates OGTT-2 hours, reduces plasma insulin levels and diminishes insulin resistance, as indicated by HOMA-IR improvement.
SA-05 THE MOTILITY OF THE ESOPHAGEAL BODY: COMPARISON BETWEEN TYPE 2 DIABETICS PATIENTS AND HEALTHY INDIVIDUALS J.X. Jorge, A. Coelho, E.A. Panão, C. Simões, C.C Almeida. Instituto de Fisiologia, Fac. Medicina da Univ. de Coimbra, Serviço de Medicina e Gastrenterol, CHC Introduction: The influence of diabetes Mellitus on the esophageal motility is not well known. Some studies has diferents results.The aim of this study was to compare some motor caracteristics of the esophageal body between type 2 diabetics patients and healthy individuals. Material and Methods: A stationary esophageal manometry with 6 channels catheter has been made in 14 adults type 2 diabetics (11 males and 3 females) of mean age 54,8 years old (45-72), and 16 non diabetics healthy, 11 males and 5 females of mean age 60,2 years old (31-81). Results: In the diabetic group the waves registed was: 83,9% peristaltics, 4,4% simultaneas, 9% non transmited and 3,2% retrograds. However in the healthy group the regist was:86,2% peristaltics, 3,8% simultaneas, 14,9% non transmited and 0,56% retrograds. The percentage of diabetics patients with anormal waves up normal was: 7,1% with simultaneas, 14,3% with non transmited and 42% with retrograds waves. Between the non diabetics it was:0% with simultaneas, 18,7% with non transmited and 18% with retrograds waves. Conclusion: The anormal esophageal waves were more frequents in diabetic pacients than in healthy individuals. Particularly, the retrograd waves was significatively more frequent in type 2 diabetics patients.
SA-06 THE ASSOCIATION OF IRON STORES AND DIABETES MELLITUS TYPE II Patiakas Stefanos, Eirini Vasileiou, Vardakis Zaharias, Tsoukis Evangelos. Microbiology/Biochemistry Department of General Hospital of Gumenissa Aim: The evaluation and comparison of iron stores in patients with Diabetes Mellitus type II as well as in healthy individuals Methods: During the year 2005, 200 patients, with Diabetes Mellitus, were
examined into the General Hospital of Gumenissa, (82 men and 118 women, 57-78 years old) and 100 healthy people (42 men and 58 women, at the same age) as reference group. In both cases, HbA1c and ferritin levels were evaluated in plasma, while other causes of high ferritin levels were excluded. We used ADAMS HA-8160 and ACESS). Results: Patients with Diabetes Mellitus type II had statistically significant higher levels of ferritin comparing to the reference group (104.92±83.8, vs. 75.8±47), p<0.05. Conclusions: Patients with Diabetes Mellitus type II, had significantly higher ferritin levels comparing to healthy population, a fact that argues in favor of hemochromatosis having increased impact in Diabetes Mellitus. Small increases of Fe has been supported to contribute into the production of free radicals of Oxygen and thus to the insulin resistance. Possibly, in the future the reduction of iron stores could be an additional factor contributing in Diabetes Mellitus prevention.
SA-07 METABOLIC SYNDROME PER SE SIGNIFICANTLY INCREASES TARGET ORGAN DAMAGE IN SUBJECTS WITHOUT OVERT CARDIOVASCULAR RISK FACTORS Davide Grassi, Cristina Lippi, Stefano Necozione, Monica Michetti, Azzurra D’Aurelio, Luisa Petrazzi, Lorella Polidoro, Giuliana Properzi, Giovambattista Desideri, Claudio Ferri. Department of Internal Medicine and Public Health, University of L’Aquila Objectives: Metabolic syndrome (MS) often associated with hypertension markedly increases cardiovascular risk. Target organ damage (TOD) is more common in hypertensives with than without MS. Whether MS per se, without overt cardiovascular risk (OCVR) is associated with an increased expression of TOD is yet controversial. The current study investigated the prevalence of TOD in subjects with MS but no OCVR. Methods: MS was defined according to ATP III criteria. Considering presence or absence of hypertension as OCVR, we divided the patients in two groups (I= MS + hypertension and II= MS without OCVR), an healthy group was considered for control. Each participant was submitted to echocardiography, carotid ultrasonography, 24 h urine collection and blood pressure (BP) measures. Results: 158 subjects (26.8%) had MS. 41.1% of these were without OCVR. Group I presented with higher BP levels than group II (p<.05). Prevalence of microalbuminuria and increased IMT (83.8 vs 75.3% and 21.5 vs 18.4%, respectively) was not statistically different, while prevalence of LVH (29.0 vs 6.1%, respectively), was significantly higher (p <.001) in I respect to II group. Compared to II and control groups, group I showed higher albuminuria, LVMI and IMT (p<.05). Group II showed higher albuminuria respect to controls (35.7±10.7 vs 20.7±5.3 mg/24h, respectively, p<.05). Insulin resistance was significantly (p<.05) higher in I and II respect to control group. In the population studied, multivariate analysis indicated impaired fasting glucose as independent risk factor for microalbuminuria, obesity for impaired IMT and high diastolic BP levels for microalbuminuria and LVH. Conclusion: Our study suggested that: 1) MS per se leads to TOD and combined hypertension entails additional CVR in this population; 2) Presence of TOD should be researched in apparently healthy subjects presenting with MS; 3) Lifestyle changes and/or combined drug therapy should be eventually considered in all subjects with MS.
Saturday, 10 May 2008, 9.45–11.15
Room B
Clinical Cases SA-08 CUTANEOUS, ARTICULAR, PULMONARY AND GASTROINTESTINAL SARCOIDOSIS – UNUSUAL FORM OF SYSTEMIC PRESENTATION Andrea Mateus, Arlindo Guimas, João Correia, Abilio Reis, Nelson Rocha. Hospital Geral Santo António - Medicina 1 Sarcoidosis is a systemic disease of unknown etiology. The diagnosis is based on suggestive clinical and radiological findings and by the presence of noncaseating granulomas at sites of disease involvement. Many atypical presentations of Sarcoidosis have been described. Distintion between Sarcoidosis and Tuberculosis is not easy because of the many clinical and histological features they share.