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Standardization of insulin tolerance test (ITT) in Brazilian population
Poster Session I
S 102
Subjects and methods: 159 healthy children(11.2-14.6yrs)were studied. Blood samples for glucose, insulin and lipids were collected fasting, lhr and 2hrs following a standard meal. The fasting insulin resistance index(FIR/) was calculated as a marker of insulin resistance.Blood pressure was recorded. E-selectin, Plasminogen activator inhibitor(PAI) and fibrinogen were measured as markers of endothelial and fibrinolytic activity. Various anthropometric measurements were made. The results are summarised in the table below (* denotes statistical significance). Skinfoldthicknessat four sites cholesterol HDL/totalcholesterol triglycerides fastingglucose fastinginsulin FIRI E-selectin fibrinogen PAI Systolicbloodp r e s s u r e Diastolicbloodp r e s s u r e
r=0.179,p=0.016" r=-0.356,p<0.001" r=0.329,p<0.001* r=0.172,1:=0.019" r=0.23l,p=0.005* r=0.282,p=0.001* r=0.176,p=0.019* r=0.393,p<0.001* r=0.388,p<0.001* r=0.138,p=0.046" r=0.206,p--0.00l*
Waisthip ratio r=0.190, i~0.011" r=-0.209,p=O.006 * r---0.170,p=0.021* r=0.261,p--0.001" r=0.215,p=0.008* r=0.257,p---0.002* r=0.21l,p=0.007* r=0.258,p=0.001* r=0.164,p<0.001" r=0.048,p.--0.277 r=0.107,p=0.096
Conclusions: We have clearly demonstrated a relationship between markers of obesity and glucose, insulin, and lipid levels in children. Furthermore we have shown that markers of obesity may also be associated with changes in endothelial and fibrinolytic function. This emphasises the importance of developing effective strategies to reduce the increasing burden of obesity in childhood and to minimise its potential effect on later health.
P439 Standardization of Insulin Tolerance Test (ITT) in Brazilian Population BRUNO GELONEZE, Sylka O. Rodovalho, Candida Parisi, Marcela R. Picolo, Enrico M. Repetto, Marcos A. Tambascia. Endocrinology,
UNICAMP, Campinas, SP, Brazil Type 2 Diabetes Mellitus (DM2) is the association of insulin resistance and relative insulin deficiency. In some cases the main responsible ethyologic factor is resistance but diabetes is a progressive disease and the deficiency can predominate later. A comprehensive estimation of insulin resistance in each particular patient could be useful for helping the kind of antidiabetic agent prescribed. Furthermore there is increasing interest in studying insulin resistance in epidemiological and clinical trials, Several studies have been showing significant differences in insulin sensitivity among ethnical groups. There are several methods to the evaluation of insulin resistance and ITT is one of the most widely used although it is necessary to validate it in any racial groups. This study is to validate the insulin tolerance test in typical Brazilian population, which is composed by a mixture of Caucasians, Natives and Africans. We analysed 155 normal subjects classified by oral GTT, 36 impaired glucose tolerance (IGT) and 56 DM2 according to ADA 1997 divided also by grades of BMI. The insulin tolerance test was used to discriminate different degrees of insulin sensitivity in obesity and in DM2. The insulin-induced disposal rate (kitt -%/min) was calculated from the slope of regression line of logarithm of blood glucose against time during the first 3-15 minutes after IV 0.1 U of human regular insulin/kg of body weight. We found a significant negative correlation between kitt and BMI in all sub-groups (r = -0.45, p < 0.01). Results are summarised in the table. BMI (kg/m2) Normal IGT DM2
<25
30-40
>40
6.4 4-2.4(17) 5.14-1.2 (7) 3.24-2.0 (18)
4.04-2.1 (77) 3.4::t:1.5(10) 2.84-2.1 (17)
3.34-1.5 (61) 2.44-1.0 (19) 1.84-1.2(21)
The kitt in the Brazilian population, which has been composed by miscegenation of ethnical groups, has the ability to discriminate alterations in insulin sensitivity by different grades of obesity and glucose tolerance. Diabetic patients present significant decrease in insulin sensitivity compared to IGT and normal subjects. Epidemiological studies and clinical trials can be done using this methodology to estimate insulin resistance.
P440 Proinsulin/lnsulin Ration Evaluation as a Possible Marker for Glucose Intolerance Among Women with Previous Gestational Diabetes Mellitus (GDM) ADRIANA C. FORTI t.2, Tania M.B.L. Ferraz 2,3, Arley A. Peter 2'3, Eni T.E Pessoa 1, Rosa M.S. Mota. / Centro Integrado de Diabetes e
Hiopertensao, Secretaria de Saude do Ceara, Fortaleza, Ceara, Brazil; 2 Internal Medicine, Federal University of Ceara, Fortaleza, Ceara, Brazil; 3 Hospital Geral de Fortaleza, Secretaria de Saude do Ceara, Fortaleza, Ceara, Brazil The elevation of the proinsulirdinsulin ration is an indicator of the initial B-cells dysfunction due to the liberation of mature pancreatic granules. The purpose of this work is to evaluate the relation of the elevation of proinsulin/insulin ratio and future glucose tolerance dysfunction in women with normal glucose tolerance (NGT) And GDM. 70 women with gestational diabetes and 108 control women were evaluated for glucose intolerance with GTT-75g (WHO, 1988) after 5 years of GDM. The jejum and after 2 hours proinsulin and insulin dosages were done by RIE, in pMol unit. It was used the Kolmogorov-Smimov statistical test for comparison of data normality and T-student test to compare the means. Comparison between GDM, control and glucose intolerance is showed in the table. Patients with NGT (case versus control): jejum proinsulin (p=0.05); 2-hours proinsulin (p=0.40); jejum PI/I ratio(p=0.83); 2-hours PI/I ratio (p=0.88). Patients with GDM/GI(case vs control): jejum proinsulin (p=0.99), 2-hours proinsulin (p--0.93); jejum PI/I ratio (p=0.39), 2hours PI/I ratio (p--0.00). PUI ratio (case versus control): jejum (12.2 vs 9.3; p=0.39); 2-hours (12 vs 5.4; p=0.00). The data show that women with GDM 5 years ago with NGT actually have s ignifitacive higher jejum proinsulin levels than women without previous GDM (p<0.05). They don't have significative difference of the PI/I ratio. The 2-hours PI/I ratio in women with previous and actual GDM/GI was higher than patients without GDM(p,0.05). Cases(n=70)
Control(n=108)
NGT(n=38) DM/GI(n=32) p Proinsulin Jejum (pMol) 2-hours Proinsulin/ Jejum insulin(%) 2-hours
4.394-0.2 24.44-3.2 9.84-0 9.94-0
5.84-0.6 46.34-5.2 12~24-0 124-0
0.007 0.001 0.099 0.542
NGT(n=81) DM/GI(n=27) p 4.24-0.2 25.64-2 12.44-0 9.3d:0
6.24-0.9 40-t-3.7 9.34-0 5.44-0
0.010 0.001 0.210 0.000
The conclusion is that the Pi/I ratio seems to be not a good marker for the development of DM 2 in women with previous GDM, although these patients have more compromised pancreatic function than normal patients.
P441 Risk Factors for Persistent Glucose In~lerance in Women with Gestational Diabetes ADRIANA C. FORTI 1,2, Tania M.B.L. Ferraz 2,3, Arley A. Peter 2'3, Eni T.F. Pessoa I, Rosa M.S. Mota. / Centro Integrado de Diabetes e
Hipertensao, Secretaria de Saude do Ceara, Fortaleza, Ceara, Brazil; 2 Internal Medicine, Federal University of Ceara, Fortaleza, Ceara, Brazil; 3Hospital Geral de Fortaleza, Secretaria de Saude do Ceara, Fortaleza, Ceara, Brazil The aim of this presentation it to evaluate the risk factors that can predict the development of future diabetes or glucose intolerance in women with
S 102
Subjects and methods: 159 healthy children(11.2-14.6yrs)were studied. Blood samples for glucose, insulin and lipids were collected fasting, lhr and 2hrs following a standard meal. The fasting insulin resistance index(FIR/) was calculated as a marker of insulin resistance.Blood pressure was recorded. E-selectin, Plasminogen activator inhibitor(PAI) and fibrinogen were measured as markers of endothelial and fibrinolytic activity. Various anthropometric measurements were made. The results are summarised in the table below (* denotes statistical significance). Skinfoldthicknessat four sites cholesterol HDL/totalcholesterol triglycerides fastingglucose fastinginsulin FIRI E-selectin fibrinogen PAI Systolicbloodp r e s s u r e Diastolicbloodp r e s s u r e
r=0.179,p=0.016" r=-0.356,p<0.001" r=0.329,p<0.001* r=0.172,1:=0.019" r=0.23l,p=0.005* r=0.282,p=0.001* r=0.176,p=0.019* r=0.393,p<0.001* r=0.388,p<0.001* r=0.138,p=0.046" r=0.206,p--0.00l*
Waisthip ratio r=0.190, i~0.011" r=-0.209,p=O.006 * r---0.170,p=0.021* r=0.261,p--0.001" r=0.215,p=0.008* r=0.257,p---0.002* r=0.21l,p=0.007* r=0.258,p=0.001* r=0.164,p<0.001" r=0.048,p.--0.277 r=0.107,p=0.096
Conclusions: We have clearly demonstrated a relationship between markers of obesity and glucose, insulin, and lipid levels in children. Furthermore we have shown that markers of obesity may also be associated with changes in endothelial and fibrinolytic function. This emphasises the importance of developing effective strategies to reduce the increasing burden of obesity in childhood and to minimise its potential effect on later health.
P439 Standardization of Insulin Tolerance Test (ITT) in Brazilian Population BRUNO GELONEZE, Sylka O. Rodovalho, Candida Parisi, Marcela R. Picolo, Enrico M. Repetto, Marcos A. Tambascia. Endocrinology,
UNICAMP, Campinas, SP, Brazil Type 2 Diabetes Mellitus (DM2) is the association of insulin resistance and relative insulin deficiency. In some cases the main responsible ethyologic factor is resistance but diabetes is a progressive disease and the deficiency can predominate later. A comprehensive estimation of insulin resistance in each particular patient could be useful for helping the kind of antidiabetic agent prescribed. Furthermore there is increasing interest in studying insulin resistance in epidemiological and clinical trials, Several studies have been showing significant differences in insulin sensitivity among ethnical groups. There are several methods to the evaluation of insulin resistance and ITT is one of the most widely used although it is necessary to validate it in any racial groups. This study is to validate the insulin tolerance test in typical Brazilian population, which is composed by a mixture of Caucasians, Natives and Africans. We analysed 155 normal subjects classified by oral GTT, 36 impaired glucose tolerance (IGT) and 56 DM2 according to ADA 1997 divided also by grades of BMI. The insulin tolerance test was used to discriminate different degrees of insulin sensitivity in obesity and in DM2. The insulin-induced disposal rate (kitt -%/min) was calculated from the slope of regression line of logarithm of blood glucose against time during the first 3-15 minutes after IV 0.1 U of human regular insulin/kg of body weight. We found a significant negative correlation between kitt and BMI in all sub-groups (r = -0.45, p < 0.01). Results are summarised in the table. BMI (kg/m2) Normal IGT DM2
<25
30-40
>40
6.4 4-2.4(17) 5.14-1.2 (7) 3.24-2.0 (18)
4.04-2.1 (77) 3.4::t:1.5(10) 2.84-2.1 (17)
3.34-1.5 (61) 2.44-1.0 (19) 1.84-1.2(21)
The kitt in the Brazilian population, which has been composed by miscegenation of ethnical groups, has the ability to discriminate alterations in insulin sensitivity by different grades of obesity and glucose tolerance. Diabetic patients present significant decrease in insulin sensitivity compared to IGT and normal subjects. Epidemiological studies and clinical trials can be done using this methodology to estimate insulin resistance.
P440 Proinsulin/lnsulin Ration Evaluation as a Possible Marker for Glucose Intolerance Among Women with Previous Gestational Diabetes Mellitus (GDM) ADRIANA C. FORTI t.2, Tania M.B.L. Ferraz 2,3, Arley A. Peter 2'3, Eni T.E Pessoa 1, Rosa M.S. Mota. / Centro Integrado de Diabetes e
Hiopertensao, Secretaria de Saude do Ceara, Fortaleza, Ceara, Brazil; 2 Internal Medicine, Federal University of Ceara, Fortaleza, Ceara, Brazil; 3 Hospital Geral de Fortaleza, Secretaria de Saude do Ceara, Fortaleza, Ceara, Brazil The elevation of the proinsulirdinsulin ration is an indicator of the initial B-cells dysfunction due to the liberation of mature pancreatic granules. The purpose of this work is to evaluate the relation of the elevation of proinsulin/insulin ratio and future glucose tolerance dysfunction in women with normal glucose tolerance (NGT) And GDM. 70 women with gestational diabetes and 108 control women were evaluated for glucose intolerance with GTT-75g (WHO, 1988) after 5 years of GDM. The jejum and after 2 hours proinsulin and insulin dosages were done by RIE, in pMol unit. It was used the Kolmogorov-Smimov statistical test for comparison of data normality and T-student test to compare the means. Comparison between GDM, control and glucose intolerance is showed in the table. Patients with NGT (case versus control): jejum proinsulin (p=0.05); 2-hours proinsulin (p=0.40); jejum PI/I ratio(p=0.83); 2-hours PI/I ratio (p=0.88). Patients with GDM/GI(case vs control): jejum proinsulin (p=0.99), 2-hours proinsulin (p--0.93); jejum PI/I ratio (p=0.39), 2hours PI/I ratio (p--0.00). PUI ratio (case versus control): jejum (12.2 vs 9.3; p=0.39); 2-hours (12 vs 5.4; p=0.00). The data show that women with GDM 5 years ago with NGT actually have s ignifitacive higher jejum proinsulin levels than women without previous GDM (p<0.05). They don't have significative difference of the PI/I ratio. The 2-hours PI/I ratio in women with previous and actual GDM/GI was higher than patients without GDM(p,0.05). Cases(n=70)
Control(n=108)
NGT(n=38) DM/GI(n=32) p Proinsulin Jejum (pMol) 2-hours Proinsulin/ Jejum insulin(%) 2-hours
4.394-0.2 24.44-3.2 9.84-0 9.94-0
5.84-0.6 46.34-5.2 12~24-0 124-0
0.007 0.001 0.099 0.542
NGT(n=81) DM/GI(n=27) p 4.24-0.2 25.64-2 12.44-0 9.3d:0
6.24-0.9 40-t-3.7 9.34-0 5.44-0
0.010 0.001 0.210 0.000
The conclusion is that the Pi/I ratio seems to be not a good marker for the development of DM 2 in women with previous GDM, although these patients have more compromised pancreatic function than normal patients.
P441 Risk Factors for Persistent Glucose In~lerance in Women with Gestational Diabetes ADRIANA C. FORTI 1,2, Tania M.B.L. Ferraz 2,3, Arley A. Peter 2'3, Eni T.F. Pessoa I, Rosa M.S. Mota. / Centro Integrado de Diabetes e
Hipertensao, Secretaria de Saude do Ceara, Fortaleza, Ceara, Brazil; 2 Internal Medicine, Federal University of Ceara, Fortaleza, Ceara, Brazil; 3Hospital Geral de Fortaleza, Secretaria de Saude do Ceara, Fortaleza, Ceara, Brazil The aim of this presentation it to evaluate the risk factors that can predict the development of future diabetes or glucose intolerance in women with