- Email: [email protected]
W09.238 Alcohol intake in the insulin resistance syndrome
W9
Workshops The metabolic syndrome
Results The prevalence of metabolic syndrome was higher in men compared to women (10.8 vs. 6.4%, p=0.0003). In both sexes, the prevalence increased with age, but more dramatically in men. Between ages 24 and 39 years, there was a 3-fold increase in men (fi'om 4.6 to 15.9%) and a 2-fold increase in women (5.2 to 9.7%). Metabolic syndrome was associated with higher carotid IMT in both sexes. The age-adjusted IMT values were 0.600 vs. 0.571 mm in women (p=0.0019), and 0.628 vs. 0.589 mm in men (p<0.0001), in subjects with and without the metabolic syndrome, respectively. Conclusions The plevalence of the metabolic syndrome is higher among Finnish young adult men compared to women. The prevalence increases with age, especially in men. In both sexes, subjects with the metabolic syndrome have higher carotid IMT values suggesting increased risk for the development of atherosclerosis.
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PREVALENCE, TREATMENT AND CONTROL OF DYSLIPIDAEMIA IN A CANARIAN POPULATION. RELATIONSHIP WITH DIABETES MELLITUS AND GLUCOSE INTOLERANCE. THE GUIA STUDY
F. Mart nez, A. Mac as, H. Rodr guez, I. Pefl" , C. Santana, V. S nchez, I. Garc a Puente, P. Mart nez, P. de Pablos, F. P fez. Endocrinology Dept.,
and Quality Dept., Hosp. Dr. Negr n, Las Palmas de Gran Canaria, Las Palmas, Spain Objectives: To study the prevalence, treatment and control of dyslipidaemia in out" community and its relationship with type 2 diabetes mellitus (DM-2) and impail"ed glucose tolerance (IGT). Methods: 685 subjects > 29 years were chosen at random fi'om the municipal roster of Gu a (Gran Canaria). Medication use, fasting glycemia, lipid profile, and a standard OGTT were obtained. Dyslipidaemia was defined by the Thh'd European Joint Task Force (2003) as: total cholesterol > 6.5 mmol/1, o1" LDL cholesterol > 4 mmol/1, or HDL-cholesterol < 1 mmol/1, (men), 1.2 mmol/1, (women), o1"use of hypolipemiant drugs. Results: 69.8% of the population had dyslipidaemia, 18.4% of them used hypolipemiant drugs; and 2.0% (15.9% of the Ueated patients) had a norrnal lipid profile. 65.7% of the norrnoglycemic subjects, 72.6% of the IGT subjects, and 80.7% of the DM-2 subjects had dyslipidaemia (c2 0.003); of them, 13.9% of the norrnoglycemic, 17.1% of the IGT and 31.2% of the DM-2 subjects were treated (c2 0.000); 2.1% of the norrnoglycemic, 1.2 of the IGT and 6.4% of the DM-2 subjects with dyslipidaemia had norrnal lipid profile (c2 0.044). Conclusion: The plevalence of dyslipidaemia in out" population is very high, and, as expected, is greater in glucose intolerant and specially in type 2 diabetic subjects. Dyslipidaemic subjects are undertreated: only 1/6 of them receive drug treatment, and of these only 1/6 are well conU'olled; but on the other hand, treatment seems to be a little more intensive (and successful) in type 2 diabetic subjects.
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Martn-L zaro
55
values were 10-156-224-174-160-72-14-7 pmol/dl in the first OSTT; and 9-25-25-22-17-18-14-9 pmol/dl in the second (p< 0.05 at 30-60-90-120-180 minutes). The AUC for insulin were 29425 min-pmol/dl in the first OSTT, and 5347 min-pmol/dl in the second (p = 0.000). Conclusions: Acarbose is very effective and well tolerated in the treatment of post-gastroplasty dumping syndrome in non-diabetic morbidly obese patients: decreases dramatically (>80%) insulin secretion and prevents reactive hypoglycemias. It should be considered when dietary therapy fails.
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ADDITION OF MANIDIPINE IN TYPE 2 DIABETIC PATIENTS WITH UNCONTROLLED HYPERTENSION AND MICROALBUMI~URIA: TIGHT ASSOCIATION BETWEEN BLOOD PRESSURE REDUCTION AND DECREASE IN ALBUMIN EXCRETION. THE AMANDHA TRIAL
F. Mart nez, M. S iz. Endocrinology Dept., Hospital Dr. Negr n, Las Palmas de Gran Canaria, CAP Rambla, Tarrasa, Spain Objective: To study the effect of the addition of Manidipine to the treatment of type 2 diabetic patients with uncontrolled microalbuminut'ia and hypertension Methods: 26 patients with type 2 diabetes and hypertension who after at least 6 months of full dose treatment with an ACEI or ARB maintained BP > 130/80 mmHg and microalbuminut'ia were recruited. Manidipine 20 mg was added; after 12 weeks, the measurements were repeated; compliance was assessed by pill counting and tolerance by questionnah'e. Results: 25 patients completed U'eatment, one withdrew because of ankle oedema; 23 had compliance >80% and 2 >50%, two patients reported mild and transient side effects (hypotension, headache). The mean SBP and DBP reductions were 17.9 (95% CI 14.7-21.1, p=0.002) and 6.5 mmHg (95% CI 4.2-8.8, p=0.005). 11 of the patients (44%) achieved BP <130/80 mmHg. The percentual reduction of albumin excretion was 59.9% (95% CI 47.6-72.2, p=0.006) and in 7 patients (28%) was leduced below the target (20 ~g/min). A linear regression study (reduction in mean arterial pleSSUle vs. percentual reduction of albumin excretion) showed a tight association between both variables (Pearson's R = 0.76, p=0.000, intercept 2.3 mmHg; 95% CI: -3.5 - 8.1, p=0.72) Conclusions: The addition of Manidipine on top of an ACEI o1"ARB is a remarkably effective and well tolerated option in the u'eatment of these patients, achieving a substantial drop in blood pressure and a ch'amatic reduction in albumin excretion. Both effects were tightly and linearly COlxelated, without evidence of any BP-independent effect.
~
ALCOHOL INTAKE IN THE INSULIN RESISTANCE SYNDROME
J. Mart n-L zaro, A. Becen'a. Universidad de Alcal , Madrid, Spain ACARBOSE IN THE TREATMENT OF POST-GASTROPLASTY DUMPING SYNDROME IN MORBIDLY OBESE NON DIABETIC PATIENTS AFTER FAILURE OF DIETARY TREATMENT
F. Mart nez. Endocrinology Dept., Hosp Dr. Negr n, Las Palmas de Gran
Canaria, Las Palmas, Spain Objectives: To study the safety and effectivity of acarbose in non-diabetic morbidly obese patients with post-gastroplasty dumping syndrome (including proven reactive hypoglycemia), after the failut'e of standard dietary therapy. Patients and Methods: Seven such patients were recruited; an oral 75 mg sucrose tolerance test (OSTT) was performed, measut'ing glucose and insulin at 0-30-60-90-120-150-180-240-300 minutes. Afterwards, they began therapy with 50 mg of acarbose daily; the dose was progressively increased up to 100 mg/8h, or until the maximum tolerated dose. After 3 months the OSTT was repeated; the patients had theft" usual dose of acarbose with the sucrose load. Results: The mean dose of acarbose was 258 rag/day; 5 patients had gastrointestinal symptoms at the beginning of treatment; one withdrew and was excluded fi'om analysis. Reactive hypoglycemias disappeared in 5 patients and improved in the other. Mean glycemias in the first OSTT wele 5.2-7.4-8.3-7.2-7.6-4.3-3.4-3.7 retool/l, in the second 4.8-5.2-7.2-6.2-5.05.5-5.6-5.4 retool/1 (p < 0.05 at 30-120-240-300 minutes; pafl'ed t-test); the minimum glycemia in the second OSTT was 4.4 retool/1. The mean insulin
Habitual and moderate alcohol intake (<15 g per day) may modify the relationship between some cardiovascular risk factors (CRF) and the Insulin Resistance Syndrome (IRS). High or abusive alcohol consumption is associated with an increased plasma concentration of homocysteine and aggravation of cardiovascular risk factors. But the effect of low to moderate consumption on the concentration of homocysteine in the metabolic syndrome has been inconsistent. In order to study cardiovascular risk factors prospectively in a population with IRS and to evaluate the effect of moderate alcohol intake on CRF among these patients. We prospectively studied population of 1,347 nondiabetic Spanish subjects, 633 women and 714 men, aged 31-84 years (43 -4- 5), with IRS (ATP III criteria). As Insulin Resistance Index we used HOMA score: fasting insulin (uU/mL) x fasting plasmatic glucose (mmol/1)/22.5. Homocysteine was studied by fluorescence polarization immunoassay and Statistical Analyses with S PS S 10.0. Alcohol drinkers were more fi'equent among men than women at baseline (40% vs. 9%). No differences have been found between drinkers and nondrinkers in age, body mass index, waist-hip ratio, serum LDL, HDL, triglycerides, uric acid, insulin levels, insulin resistance, fasting serum glucose and diastolic blood pressut'e. Drinkers presented lower systolic blood pressure (SBP)(138.5 424.8 vs. 150.7 4- 25.8 mmHg, p = 0.000) and plasma homocysteine (4.8 43.5 vs. 7.6 4- 5.3 uM/L, p = 0.015). Our findings suggest a beneficial effect of habitual and moderate alcohol intake decreasing total homocysteine levels and SBP in the IRS improving endothelial function.
74th EAS Congress, 17-20 April 2004, Seville, Spain
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Workshops The metabolic syndrome
Results The prevalence of metabolic syndrome was higher in men compared to women (10.8 vs. 6.4%, p=0.0003). In both sexes, the prevalence increased with age, but more dramatically in men. Between ages 24 and 39 years, there was a 3-fold increase in men (fi'om 4.6 to 15.9%) and a 2-fold increase in women (5.2 to 9.7%). Metabolic syndrome was associated with higher carotid IMT in both sexes. The age-adjusted IMT values were 0.600 vs. 0.571 mm in women (p=0.0019), and 0.628 vs. 0.589 mm in men (p<0.0001), in subjects with and without the metabolic syndrome, respectively. Conclusions The plevalence of the metabolic syndrome is higher among Finnish young adult men compared to women. The prevalence increases with age, especially in men. In both sexes, subjects with the metabolic syndrome have higher carotid IMT values suggesting increased risk for the development of atherosclerosis.
•
PREVALENCE, TREATMENT AND CONTROL OF DYSLIPIDAEMIA IN A CANARIAN POPULATION. RELATIONSHIP WITH DIABETES MELLITUS AND GLUCOSE INTOLERANCE. THE GUIA STUDY
F. Mart nez, A. Mac as, H. Rodr guez, I. Pefl" , C. Santana, V. S nchez, I. Garc a Puente, P. Mart nez, P. de Pablos, F. P fez. Endocrinology Dept.,
and Quality Dept., Hosp. Dr. Negr n, Las Palmas de Gran Canaria, Las Palmas, Spain Objectives: To study the prevalence, treatment and control of dyslipidaemia in out" community and its relationship with type 2 diabetes mellitus (DM-2) and impail"ed glucose tolerance (IGT). Methods: 685 subjects > 29 years were chosen at random fi'om the municipal roster of Gu a (Gran Canaria). Medication use, fasting glycemia, lipid profile, and a standard OGTT were obtained. Dyslipidaemia was defined by the Thh'd European Joint Task Force (2003) as: total cholesterol > 6.5 mmol/1, o1" LDL cholesterol > 4 mmol/1, or HDL-cholesterol < 1 mmol/1, (men), 1.2 mmol/1, (women), o1"use of hypolipemiant drugs. Results: 69.8% of the population had dyslipidaemia, 18.4% of them used hypolipemiant drugs; and 2.0% (15.9% of the Ueated patients) had a norrnal lipid profile. 65.7% of the norrnoglycemic subjects, 72.6% of the IGT subjects, and 80.7% of the DM-2 subjects had dyslipidaemia (c2 0.003); of them, 13.9% of the norrnoglycemic, 17.1% of the IGT and 31.2% of the DM-2 subjects were treated (c2 0.000); 2.1% of the norrnoglycemic, 1.2 of the IGT and 6.4% of the DM-2 subjects with dyslipidaemia had norrnal lipid profile (c2 0.044). Conclusion: The plevalence of dyslipidaemia in out" population is very high, and, as expected, is greater in glucose intolerant and specially in type 2 diabetic subjects. Dyslipidaemic subjects are undertreated: only 1/6 of them receive drug treatment, and of these only 1/6 are well conU'olled; but on the other hand, treatment seems to be a little more intensive (and successful) in type 2 diabetic subjects.
•
Martn-L zaro
55
values were 10-156-224-174-160-72-14-7 pmol/dl in the first OSTT; and 9-25-25-22-17-18-14-9 pmol/dl in the second (p< 0.05 at 30-60-90-120-180 minutes). The AUC for insulin were 29425 min-pmol/dl in the first OSTT, and 5347 min-pmol/dl in the second (p = 0.000). Conclusions: Acarbose is very effective and well tolerated in the treatment of post-gastroplasty dumping syndrome in non-diabetic morbidly obese patients: decreases dramatically (>80%) insulin secretion and prevents reactive hypoglycemias. It should be considered when dietary therapy fails.
~
ADDITION OF MANIDIPINE IN TYPE 2 DIABETIC PATIENTS WITH UNCONTROLLED HYPERTENSION AND MICROALBUMI~URIA: TIGHT ASSOCIATION BETWEEN BLOOD PRESSURE REDUCTION AND DECREASE IN ALBUMIN EXCRETION. THE AMANDHA TRIAL
F. Mart nez, M. S iz. Endocrinology Dept., Hospital Dr. Negr n, Las Palmas de Gran Canaria, CAP Rambla, Tarrasa, Spain Objective: To study the effect of the addition of Manidipine to the treatment of type 2 diabetic patients with uncontrolled microalbuminut'ia and hypertension Methods: 26 patients with type 2 diabetes and hypertension who after at least 6 months of full dose treatment with an ACEI or ARB maintained BP > 130/80 mmHg and microalbuminut'ia were recruited. Manidipine 20 mg was added; after 12 weeks, the measurements were repeated; compliance was assessed by pill counting and tolerance by questionnah'e. Results: 25 patients completed U'eatment, one withdrew because of ankle oedema; 23 had compliance >80% and 2 >50%, two patients reported mild and transient side effects (hypotension, headache). The mean SBP and DBP reductions were 17.9 (95% CI 14.7-21.1, p=0.002) and 6.5 mmHg (95% CI 4.2-8.8, p=0.005). 11 of the patients (44%) achieved BP <130/80 mmHg. The percentual reduction of albumin excretion was 59.9% (95% CI 47.6-72.2, p=0.006) and in 7 patients (28%) was leduced below the target (20 ~g/min). A linear regression study (reduction in mean arterial pleSSUle vs. percentual reduction of albumin excretion) showed a tight association between both variables (Pearson's R = 0.76, p=0.000, intercept 2.3 mmHg; 95% CI: -3.5 - 8.1, p=0.72) Conclusions: The addition of Manidipine on top of an ACEI o1"ARB is a remarkably effective and well tolerated option in the u'eatment of these patients, achieving a substantial drop in blood pressure and a ch'amatic reduction in albumin excretion. Both effects were tightly and linearly COlxelated, without evidence of any BP-independent effect.
~
ALCOHOL INTAKE IN THE INSULIN RESISTANCE SYNDROME
J. Mart n-L zaro, A. Becen'a. Universidad de Alcal , Madrid, Spain ACARBOSE IN THE TREATMENT OF POST-GASTROPLASTY DUMPING SYNDROME IN MORBIDLY OBESE NON DIABETIC PATIENTS AFTER FAILURE OF DIETARY TREATMENT
F. Mart nez. Endocrinology Dept., Hosp Dr. Negr n, Las Palmas de Gran
Canaria, Las Palmas, Spain Objectives: To study the safety and effectivity of acarbose in non-diabetic morbidly obese patients with post-gastroplasty dumping syndrome (including proven reactive hypoglycemia), after the failut'e of standard dietary therapy. Patients and Methods: Seven such patients were recruited; an oral 75 mg sucrose tolerance test (OSTT) was performed, measut'ing glucose and insulin at 0-30-60-90-120-150-180-240-300 minutes. Afterwards, they began therapy with 50 mg of acarbose daily; the dose was progressively increased up to 100 mg/8h, or until the maximum tolerated dose. After 3 months the OSTT was repeated; the patients had theft" usual dose of acarbose with the sucrose load. Results: The mean dose of acarbose was 258 rag/day; 5 patients had gastrointestinal symptoms at the beginning of treatment; one withdrew and was excluded fi'om analysis. Reactive hypoglycemias disappeared in 5 patients and improved in the other. Mean glycemias in the first OSTT wele 5.2-7.4-8.3-7.2-7.6-4.3-3.4-3.7 retool/l, in the second 4.8-5.2-7.2-6.2-5.05.5-5.6-5.4 retool/1 (p < 0.05 at 30-120-240-300 minutes; pafl'ed t-test); the minimum glycemia in the second OSTT was 4.4 retool/1. The mean insulin
Habitual and moderate alcohol intake (<15 g per day) may modify the relationship between some cardiovascular risk factors (CRF) and the Insulin Resistance Syndrome (IRS). High or abusive alcohol consumption is associated with an increased plasma concentration of homocysteine and aggravation of cardiovascular risk factors. But the effect of low to moderate consumption on the concentration of homocysteine in the metabolic syndrome has been inconsistent. In order to study cardiovascular risk factors prospectively in a population with IRS and to evaluate the effect of moderate alcohol intake on CRF among these patients. We prospectively studied population of 1,347 nondiabetic Spanish subjects, 633 women and 714 men, aged 31-84 years (43 -4- 5), with IRS (ATP III criteria). As Insulin Resistance Index we used HOMA score: fasting insulin (uU/mL) x fasting plasmatic glucose (mmol/1)/22.5. Homocysteine was studied by fluorescence polarization immunoassay and Statistical Analyses with S PS S 10.0. Alcohol drinkers were more fi'equent among men than women at baseline (40% vs. 9%). No differences have been found between drinkers and nondrinkers in age, body mass index, waist-hip ratio, serum LDL, HDL, triglycerides, uric acid, insulin levels, insulin resistance, fasting serum glucose and diastolic blood pressut'e. Drinkers presented lower systolic blood pressure (SBP)(138.5 424.8 vs. 150.7 4- 25.8 mmHg, p = 0.000) and plasma homocysteine (4.8 43.5 vs. 7.6 4- 5.3 uM/L, p = 0.015). Our findings suggest a beneficial effect of habitual and moderate alcohol intake decreasing total homocysteine levels and SBP in the IRS improving endothelial function.
74th EAS Congress, 17-20 April 2004, Seville, Spain
iiiiiiiiiiiiiiiiiiiiii iiiiii..".O.iiiiiiiiiiiiiiii
iiiii iiiiiiiiiiiiiii iiiiii.-O.'iiiiiiiiiiiiiiii