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Obesity is strongly associated with insulin resistance, type 2 diabetes, cardiovascular diseases and dyslipidemia. How these seemingly distinctive diseases cluster together as the metabolic syndrome is a scientifically intriguing and clinically important question, but not well understood. Recent studies indicate that chronic systemic inflammation may be a cause behind the syndrome and that the adipose tissue may contribute to the inflammation since it is not only a storage depot for excess fat, but also is an endocrine organ secreting many polypeptides, known as adipokines. Dysregulation of adipokines may be responsible for the elevation of the inflammatory state in obesity and obesity-associated comorbidities. Numerous studies have investigated the change of adipokines in obesity and diabetes conditions, but the data from Chinese patients are very limited. In this study, we measured the serum levels of several representative adipokines in obese and diabetic Chinese patients treated with rosiglitazone. In non-diabetic subjects, the serum levels of serum amyloid A (SAA), C-reactive protein (CRP) and TNFa in obese people (BMI ≥ 24, n = 24) was significantly higher than the lean subjects (BMI < 24, n = 26, p < 0.01). In contrast, adiponectin levels were significantly lower in the obese group (p < 0.01). On the other hand, no difference in IL-6 and resistin levels was found between the lean and obese groups. Moreover, these adipokines were measured in 34 impaired glucose regulation (IGR) patients and 44 new-onset type 2 diabetes patients (T2D) patients before and after the treatment with rosiglitazone at 4 mg/day for 12 weeks. The rosiglitazone did not change BMI in both groups but decreased fasting glucose and HbA1c levels in the T2D group. The treatment reduced CRP, TNFa and SAA by 11-39% and increased adiponectin by 82% with statistical significance. In conclusion, we found that inflammatory adipokines were elevated in obesity and decreased in diabetics after rosiglitazone treatment, supporting that adipokines may be a mediator in the metabolic syndrome. [ABSTRACT FROM AUTHOR]

NTRODUCTION: In Asia, patients with type 2 diabetes mellitus (T2DM) often have suboptimal glycemic control for many years prior to initiating basal insulin. Active titration of basal insulin is also required to improve glycemic outcomes. This pooled analysis was conducted to determine the impact of patient baseline covariates on the required dose of basal insulin and treatment response, for the improved management of Asian patients with T2DM. METHODS: Data on insulin-naïve Asian patients with T2DM who initiated and fully titrated insulin glargine 100 U/mL (Gla-100) for ≥ 20 weeks were pooled from seven randomized, controlled, treat-to-target trials. Covariance and multivariate linear/logistic regression analyses were applied to determine the impact of the baseline covariates on Gla-100 dose (primary outcome) and treatment response (secondary outcomes) at week 24 for patients from Asia (N = 724) and from China alone (n = 249). Based on the multivariate analysis for the primary outcome in the Asian population, a nomogram was developed. RESULTS: The dose of Gla-100 at week 24 was negatively correlated with age and positively correlated with body mass index (BMI) and fasting plasma glucose (FPG) at baseline in both Asian and Chinese populations. In both populations, higher baseline glycated hemoglobin (HbA1c) was associated with a lower reduction in HbA1c from baseline, higher HbA1c at week 24, and a lower chance of achieving HbA1c < 7% at week 24. The constructed nomogram enables calculation of the likely dose of Gla-100 required by Asian patients with T2DM to achieve HbA1c < 7% at week 24. CONCLUSIONS: Higher doses of Gla-100 are likely to be required in younger patients or patients with higher baseline BMI or FPG. The nomogram developed in this study can aid clinicians to titrate the dose of Gla-100 appropriately. Evidence in this pooled analysis also indicates that initiating basal insulin at a lower HbA1c can lead to greater glycemic control. [ABSTRACT FROM AUTHOR]

OBJECTIVE--The two major classes of antidiabetic drugs, sulfonylureas and metformin, may differentially affect macrovascular complications and mortality in diabetic patients. We compared the long-term effects of glipizide and metformin on the major cardiovascular events in type 2 diabetic patients who had a history of coronary artery disease (CAD). RESEARCH DESIGN AND METHODS--This study is a multicenter, randomized, double-blind, placebo-controlled clinical trial. A total of 304 type 2 diabetic patients with CAD, mean age = 63.3 years (range, 36-80 years), were enrolled. Participants were randomly assigned to receive either glipizide (30 mg daily) or metformin (1.5 g daily) for 3 years. The primary end points were times to the composite of recurrent cardiovascular events, including death from a cardiovascular cause, death from any cause, nonfatal myocardial infarction, nonfatal stroke, or arterial revascularization. RESULTS--At the end of study drug administration, both groups achieved a significant decrease in the level of glycated hemoglobin (7.1% in the glipizide group and 7.0% in the metformin group). At a median follow-up of 5.0 years, 91 participants had developed 103 primary end points. Intention-to-treat analysis showed an adjusted hazard ratio (HR) of 0.54 (95 % CI 0.30-0.90; P = 0.026) for the composites of cardiovascular events among the patients that received metformin, compared with glipizide. The secondary end points and adverse events were not significantly different between the two groups. CONCLUSIONS--Treatment with metformin for 3 years substantially reduced major cardiovascular events in a median follow-up of 5.0 years compared with glipizide. Our results indicated a potential benefit of metformin therapy on cardiovascular outcomes in high-risk patients. [ABSTRACT FROM AUTHOR]

The efficacy and safety of twice daily (BID: immediately before breakfast and dinner) and thrice daily (TID: immediately before breakfast, lunch and dinner) biphasic insulin aspart 30 (BIAsp30) were assessed in this 24-week randomised, open-labeled, parallel-group trial in China. A total of 321 type 2 diabetics (FBG≥7.8mM;HbA[sub 1c]≥7.5%) inadequately controlled with oral antidiabetic agents (OADs) were randomised (1:1) to receive BID or TID BIAsp30. Subject baseline characteristics were comparable in two groups. HbA[sub 1c] were 9.5±1.4%(BID) and 9.6±.5%(TID). FBG were 11.5±2.7mM(BID) and 11.8±3. 1mM(TID). Insulin dose was adjusted to achieve pre-meal BG target of4.4-6.1mM (APDPG 2002). After 24 weeks, HbA[sub 1c] decreased significantly in both groups (BID:-2.5%;TID:-2.8%). TID group showed superiority in HbA[sub 1c] improvement (0.3%, 95% CI: [-0.53;-0.13], p<0.01). Half of subjects achieved HbA[sub 1c] target <7.0% with BIAsp30 BID. Fifteen percent more subjects reaching HbA[sub 1c]<7.0% with BIAsp30 TID. FBG in both groups showed significant reduction (BID&TID:-4.7±0.1mM). There was no significant difference in major and minor hypoglycaemic episodes between treatments, but a significant lower risk (p<0.05) for TID treatment in the subgroup of subjects achieving the target of HbA[sub 1c]< 7.0%. Risk of nocturnal events was similar in both groups (RR=0.83,p=0.60). TID group revealed significantly lower risk of overall (RR=0.62, p<0.05) and diurnal hypoglycaemic events (RR=0.58, p<0.01). The trend of significantly lower hypoglycaemic episodes was also observed in subjects achieving target of HbA[sub 1c]<7.0%. There was no significant difference for weight gain in two groups. Mean daily insulin doses were 0.82U/kg in BID group and 0.86U/kg in TID group at the end of study. In conclusion, both twice daily and thrice daily BIAsp30 were efficacious in glycaemic control in insulin naive type 2 diabetics. The regimen of thrice daily BIAsp30 could offer greater reduction in HbA[sub 1c] and lower risk of hypoglycaemic events. More patients can reach target with treatment regimen of BIASP30 TID without increasing insulin dose and weight gain compared to BID group. [ABSTRACT FROM AUTHOR]

The article discusses a study performed to test the impact of intensive insulin therapy glycemic control and beta cell function in persons recently determined to have type 2 diabetes. Participants included 382 patients in China between September, 2004 and October, 2006. Patients were randomly assigned to receive either insulin therapy or oral hypoglycemic agents. Subsequent to normoglycemia being established, a follow-up regimen of diet and exercise was introduced. Results indicate early insulin therapy produced better outcomes than oral hypoglycemic agents.