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Diabetes linked to complex interaction
By Susan Mulley
HONG KONG – Complex interactions between increased insulin, cortisol and noradrenalin, and decreased growth hormone and adrenalin appear to underlie the pathogenisis of a cluster of disorders that includes diabetes, according to researchers here.
Speaking at the 2nd Hong Kong Diabetes and Cardiovascular Risk Factors East Meets West symposium, Dr. Julian Critchely of the Chinese University of Hong Kong reported on a study of 767 subjects recruited from the Prince of Wales Hospital and local clinics, including 60.9% with type 2 diabetes and/or hypertension, and/or dyslipidemia, and 39.1% healthy individuals.
Dr. Critchley, who is head of clinical pharmacology in the department of medicine and therapeutics, and his colleagues measured the subjects' body mass index, waist and hip circumference, blood pressure, fasting glucose, lipids, insulin, growth hormone and cortisol, 24-hour urinary noradrenalin and adrenalin excretions. All subjects had been off all medications for four weeks and none were taking insulin at the study time.
Individuals who could be "clearly categorized" included 104 controls (mean age 32 years), 66 patients with only type 2 diabetes (mean age 32 years), 87 patients with only hypertension (mean age 45 years) and 101 patients with only dyslipidemia (mean age 43 years). Many patients had more than one component of metabolic syndrome: 50% of the type 2 diabetic patients had hypertension, 23% had dyslipidemia and 51% were obese.
"Our findings showed a clustering of pathophysiological abnormalities and risk factors to varying degrees. When compared to control subjects, patients either with only diabetes, only hypertension or only dyslipidemia, were more generally and centrally obese, had higher plasma insulin, a higher insulin resistance index, higher cortisol and urinary noradrenaline but lower plasma growth hormone and urinary adrenaline excretion values (p<0.05).
"When we looked at individuals who had more than one component of metabolic syndrome ... changes across general and central obesity, across BMI ... across blood pressure ... across trigylceride quintiles ...the story was the same. Mean plasma insulin, insulin resistance, plasma cortisol and urinary noradrenaline values were correspondingly higher whereas plasma growth hormone and urinary adrenaline values were lower (P<0.001),"Dr. Critchley said.
"In Hong Kong, the prevalence of type 2 diabetes, hypertension, dyslipidemia and obesity is reaching epidemic proportions and they frequently co-exist in the general population ... It's the affluence syndrome ... triggered by lack of exercise, over-eating and chronic stress," Dr Critchley said.
© Copyright 2003 The Medical Post. All rights reserved.
By Susan Mulley
HONG KONG – Complex interactions between increased insulin, cortisol and noradrenalin, and decreased growth hormone and adrenalin appear to underlie the pathogenisis of a cluster of disorders that includes diabetes, according to researchers here.
Speaking at the 2nd Hong Kong Diabetes and Cardiovascular Risk Factors East Meets West symposium, Dr. Julian Critchely of the Chinese University of Hong Kong reported on a study of 767 subjects recruited from the Prince of Wales Hospital and local clinics, including 60.9% with type 2 diabetes and/or hypertension, and/or dyslipidemia, and 39.1% healthy individuals.
Dr. Critchley, who is head of clinical pharmacology in the department of medicine and therapeutics, and his colleagues measured the subjects' body mass index, waist and hip circumference, blood pressure, fasting glucose, lipids, insulin, growth hormone and cortisol, 24-hour urinary noradrenalin and adrenalin excretions. All subjects had been off all medications for four weeks and none were taking insulin at the study time.
Individuals who could be "clearly categorized" included 104 controls (mean age 32 years), 66 patients with only type 2 diabetes (mean age 32 years), 87 patients with only hypertension (mean age 45 years) and 101 patients with only dyslipidemia (mean age 43 years). Many patients had more than one component of metabolic syndrome: 50% of the type 2 diabetic patients had hypertension, 23% had dyslipidemia and 51% were obese.
"Our findings showed a clustering of pathophysiological abnormalities and risk factors to varying degrees. When compared to control subjects, patients either with only diabetes, only hypertension or only dyslipidemia, were more generally and centrally obese, had higher plasma insulin, a higher insulin resistance index, higher cortisol and urinary noradrenaline but lower plasma growth hormone and urinary adrenaline excretion values (p<0.05).
"When we looked at individuals who had more than one component of metabolic syndrome ... changes across general and central obesity, across BMI ... across blood pressure ... across trigylceride quintiles ...the story was the same. Mean plasma insulin, insulin resistance, plasma cortisol and urinary noradrenaline values were correspondingly higher whereas plasma growth hormone and urinary adrenaline values were lower (P<0.001),"Dr. Critchley said.
"In Hong Kong, the prevalence of type 2 diabetes, hypertension, dyslipidemia and obesity is reaching epidemic proportions and they frequently co-exist in the general population ... It's the affluence syndrome ... triggered by lack of exercise, over-eating and chronic stress," Dr Critchley said.
© Copyright 2003 The Medical Post. All rights reserved.
