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ABSTRACT Objectives: To evaluate the effect of sitagliptin treatment in early type 2 diabetes mellitus (T2DM) and the impact of different macronutrient compositions on hormones and substrates during meal tolerance tests (MTT). Materials and methods: Half of the drug-naive patients with T2DM were randomly assigned for treatment with 100 mg of sitagliptin, q.d., or placebo for 4 weeks and then submitted to 3 consecutive MTT intercalated every 48 h. The MTTs differed in terms of macronutrient composition, with 70% of total energy from carbohydrates, proteins, or lipids. After 4 weeks of washout, a crossover treatment design was repeated. Both patients and researchers were blinded, and a repeated-measures ANOVA was employed for statistical analysis. Results: Sitagliptin treatment reduced but did not normalize fasting and post-meal glucose values in the three MTTs, with lowered area-under-glucose-curve values varying from 7% to 15%. The sitagliptin treatment also improved the insulinogenic index (+86%) and the insulin/glucose (+25%), glucagon-like peptide-1/glucose (+46%) incremental area under the curves. Patients with early T2DM maintained the lowest glucose excursion after a protein- or lipid-rich meal without any major change in insulin, C-peptide, glucagon, or NEFA levels. Conclusion: We conclude that sitagliptin treatment is tolerable and contributes to better control of glucose homeostasis in early T2DM, irrespective of macronutrient composition. The blood glucose excursion during meal ingestion is minimal in protein- or fat-rich meals, which can be a positive ally for the management of T2DM. Clinical trial no: NCT00881543

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Objective: To evaluate the effect of sitagliptin treatment in early type 2 diabetes mellitus (T2DM) and the impact of different macronutrient compositions on hormones and substrates during meal tolerance tests (MTT). Methods: Half of the drug-naive patients with T2DM were randomly assigned for treatment with 100 mg of sitagliptin, q.d., or placebo for 4 weeks and then submitted to 3 consecutive MTT intercalated every 48 h. The MTTs differed in terms of macronutrient composition, with 70% of total energy from carbohydrates, proteins, or lipids. After 4 weeks of washout, a crossover treatment design was repeated. Both patients and researchers were blinded, and a repeated-measures ANOVA was employed for statistical analysis. Results: Sitagliptin treatment reduced but did not normalize fasting and post-meal glucose values in the three MTTs, with lowered area-under-glucose-curve values varying from 7% to 15%. The sitagliptin treatment also improved the insulinogenic index (+86%) and the insulin/glucose (+25%), glucagon-like peptide-1/glucose (+46%) incremental area under the curves. Patients with early T2DM maintained the lowest glucose excursion after a protein- or lipid-rich meal without any major change in insulin, C-peptide, glucagon, or NEFA levels. Conclusion: We conclude that sitagliptin treatment is tolerable and contributes to better control of glucose homeostasis in early T2DM, irrespective of macronutrient composition. The blood glucose excursion during meal ingestion is minimal in protein- or fat-rich meals, which can be a positive ally for the management of T2DM. Clinical trial no: NCT00881543.

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Diabetes is a very frequent disease and it is estimated that its prevalence will continuously increase during the next two decades. The arteriosclerotic process in diabetic patients progresses earlier and more diffusely, and it is more accelerated in the diabetic patient than in the overall population. In diabetic subjects, acute myocardial infarction (AMI) and stroke are the leading causes of death, but the presence of arterial disease is not always detected before the development of the acute arterial event. Several times, AMI is asymptomatic or present nonspecific symptoms, and it is the initial form of presentation of coronary artery disease causing an important delay in initiating cardiovascular treatment in these patients. The purpose of this review article is to discuss how to screen and early diagnose the presence of coronary artery disease in asymptomatic diabetic patients, based on new available diagnostic resources. Currently, the most recommended technique used for screening coronary artery disease in these patients is myocardial perfusion scintigraphy or stress echocardiography because of greater sensitivity and specificity in relation to the exercise test. However, technological advances have enabled the development of new imaging diagnostic methods that are less invasive than conventional coronary angiography, and which gradually gain importance in the diagnosis of coronary artery disease as they show higher effectiveness with lower invasiveness and risk. Arch Endocrinol Metab. 2016;60(2):143-51.

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ABSTRACT Diabetes is a very frequent disease and it is estimated that its prevalence will continuously increase during the next two decades. The arteriosclerotic process in diabetic patients progresses earlier and more diffusely, and it is more accelerated in the diabetic patient than in the overall population. In diabetic subjects, acute myocardial infarction (AMI) and stroke are the leading causes of death, but the presence of arterial disease is not always detected before the development of the acute arterial event. Several times, AMI is asymptomatic or present nonspecific symptoms, and it is the initial form of presentation of coronary artery disease causing an important delay in initiating cardiovascular treatment in these patients. The purpose of this review article is to discuss how to screen and early diagnose the presence of coronary artery disease in asymptomatic diabetic patients, based on new available diagnostic resources. Currently, the most recommended technique used for screening coronary artery disease in these patients is myocardial perfusion scintigraphy or stress echocardiography because of greater sensitivity and specificity in relation to the exercise test. However, technological advances have enabled the development of new imaging diagnostic methods that are less invasive than conventional coronary angiography, and which gradually gain importance in the diagnosis of coronary artery disease as they show higher effectiveness with lower invasiveness and risk. Arch Endocrinol Metab. 2016;60(2):143-51.

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O diabetes tipo 2 (DM2) é uma doença de característica evolutiva e silenciosa muito frequente e a sua prevalência vem aumentando em proporções epidêmicas, cujo maior impacto como problema importante de saúde se relaciona à associação do diabetes com o desenvolvimento da doença cardiovascular, que apresenta fatores etiopatogênicos comuns com o processo aterosclerótico, e é a principal causa de mortalidade e morbidade do paciente diabético. Estudos clínicos randomizados delonga duração têm demonstrado que a hiperglicemia crônica e presença de fatores de risco cardiovasculares associados à síndrome metabólica frequentemente observada na maioria dos pacientes com diabetes se relacionam com o desenvolvimento das complicações macro e microvasculares da doença e manutenção continuada do controle glicêmico e o tratamento dos fatores de risco podem prevenir ou retardar as complicações crônicas do diabetes, especialmente as doenças microvasculares. Nas duas últimas décadas, novos fármacos com diferentes mecanismos de ação têm sido utilizados como ferramentas valiosas para a manutenção do controle glicêmico adequado, retardando o desenvolvimento ou prevenindo a presença de complicações do diabetes, entretanto, a prevenção das complicações cardiovasculares do diabetes depende do diagnóstico e da introdução terapêutica precoce em fases iniciais da história natural da doença e o tratamento deverá ser individualizado, considerando os efeitos colaterais dos medicamentos utilizados em pacientes fragilizados ecoronariopatas.

Type 2 diabetes mellitus (DM2) is a progressive and very frequent disease and its prevalence is increasing in epidemic proportions which have a great impact as a public health problem. Cardiovascular artery diseases (CAD) are the main cause of mortality, morbidity, physical incapacity and worsening in quality of life among individuals with diabetes. Recently, long term randomized clinical studies demonstrated that the development of macro and microvascular complications of diabetes are related to chronic hyperglycemic state and to the presence of cardiovascular risk factors associated to the metabolic syndrome frequently presented in patients with DM2 as well as the therapeutic maintenance of an adequate glycemic control and the correction of cardiovascular risk factors could prevent or reduce the development of diabetes complications. Diabetes pathophysiology knowledge presented an impressive improvement during the last two decades and several new pharmacologic agents were developed for clinical care of diabetic patients reducing or preventing chronic complications, especially microvascular diabetes and neuropathic complications. However, the prevention of macrovascular complications efectivity showed to benot only dependent on strict and continuous intensive glycemic controlbut also on the concomitant treatment of cardiovascular risk factors, the precocity of treatment introduction and in avoiding hypoglycemic events that are related to increased mortality in patients with CAD. The glycemic treatment goals in elder and frail individuals and in patients with important comorbidities or cardiovascular disease should beindividualized to achieve the best global cost benefit.

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A adiponectina é um marcador metabólico, inversamente associada à RI, baixos níveis séricos têm importância como preditor de risco de desenvolvimento de DM2 e níveis elevados de adiponectina estão associados com diminuição do risco de DM2 em idosos (AU)

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Entre as variáveis analisadas, a cintura abdominal, IMC, hemoglobina glicada e adiponectina se associaram a maior grau de resistência insulínica

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A adiponectina é um marcador metabólico, inversamente associada à RI, baixos níveis séricos têm importância como preditor de risco de desenvolvimento de DM2 e níveis elevados de adiponectina estão associados com diminuição do risco de DM2 em idosos

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Entre as variáveis analisadas, a cintura abdominal, IMC, hemoglobina glicada e adiponectina se associaram a maior grau de resistência insulínica

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