The results of this study confirm that sibutramine, orlistat and metformin are all effective and safe medications that reduce cardiovascular risk and can decrease the risk of type 2 diabetes mellitus in obese females. Overall, treatment with 10 mg sibutramine bid is more effective than orlistat or metformin therapy in terms of weight reduction.

Objective: Helicobacter pylori is the major etiologic agent for chronic active gastritis, and it also plays a crucial role in gastric and duodenal ulcer disease, as well as in gastric carcinoma. H. pylori infection has been shown to decrease plasma somatostatin (SST) and increase plasma gastrin concentrations. Ghrelin is a recently discovered peptide produced mostly in the stomach of rodents and humans and is secreted into the bloodstream. There is no data in the literature about the relationship between H. pylori and ghrelin. Design: Thirty-nine age-and BMI-matched H. pylori infection positive and negative women, from whom biopsy specimens were taken during gastric endoscopy, were included in the study. Methods: Total ghrelin was measured by enzyme immunoassay (EIA) in Medistek. All samples were measured in duplicate and averaged; results differing by more than 20% were re-assayed. Two biopsy specimens from antrum, corpus and fundus were obtained. Results: Fifteen of the subjects were H. pylori negative and 24 were H. pylori positive. Age, BMI, lipid profile and insulin sensitivity indices of the groups were similar. Plasma ghrelin levels ð375:92^7:10 vs 370:00^4:14 pmol=l; P . 0:05Þ of H. pylori negative and positive groups did not differ significantly. Conclusion: H. pylori has no effect on plasma ghrelin concentration.

OBJECTIVE -In this study, we evaluated the efficacy of sibutramine in combination with hypoglycemic drugs in obese type 2 diabetic women whose glucose levels were poorly regulated.RESEARCH DESIGN AND METHODS -Female patients with type 2 diabetes, poorly controlled glucose levels, and HbA 1c Ͼ8% were randomly assigned to one of two groups. In addition to their prescribed hypoglycemic agents (maximum doses of sulfonylureas and metformin), one group (n ϭ 30) received a placebo twice daily for 6 months and the other (n ϭ 30) received sibutramine 10 mg b.i.d. for the same period.RESULTS -One patient in the sibutramine group was excluded during the study period because of hypertension; thus, a total of 29 data sets were analyzed for this group. In the placebo group, five patients had to be excluded because of low treatment efficacy, leaving a total of 25 who completed the study. Comparing the changes that occurred over 6 months in the sibutramine and placebo groups, the former showed significantly greater reductions in fasting blood glucose (P Ͻ 0.0001), second-hour postprandial blood glucose (P Ͻ 0.0001), insulin resistance (P Ͻ 0.0001), waist circumference (P Ͻ 0.0001), BMI (P Ͻ 0.0001), HbA 1c (P Ͻ 0.0001), diastolic blood pressure, pulse rate, uric acid levels, and all elements of the lipid profile except HDL cholesterol and apolipoprotein A1.CONCLUSIONS -The addition of sibutramine to oral hypoglycemic therapy resulted in significant weight loss and improvement in metabolic parameters in this patient group. Sibutramine is an effective adjunct to oral hypoglycemic therapy in obese women with type 2 diabetes. Diabetes Care 24:1957-1960, 2001M ost patients with type 2 diabetes are obese, dyslipidemic, and insulin-resistant (1,2). In most cases, high doses of hypoglycemic drugs and statins or fibrates are required, and it is usually difficult to regulate metabolic parameters. Modification of dietary habits and subsequent weight loss can improve glycemic control, insulin level, and lipid profile findings (3,4); however, unfortunately, diet restriction alone usually does not lead to adequate weight loss (3,5,6).Previous studies have shown that tight glycemic control reduces the longterm complications of the disease. The U.K. Prospective Diabetes Study (UKPDS) showed that a 1% reduction in the average HbA 1c level was associated with a 21% reduction in risk for any end point related to diabetes, 37% for microvascular complications, and 14% for myocardial infarction (7,8). The subgroup analysis of the simvastatin (4S) study showed that reducing the level of LDL cholesterol decreased cardiovascular mortality in diabetic patients (9).Recent studies on dexfenfluramine and fluoxetine have revealed that weight reduction with these agents improves glucose control and reduces HbA 1c , BMI, and blood pressure (10 -12). Sibutramine is an anti-obesity drug that induces satiety and thermogenesis (13). Administration of sibutramine has been shown to reduce weight gain, lower the levels of nonesterified fatty acids, decrease hyperins...

Administration of OPS causes a significant rise in serum phosphate, even in patients with normal CCR. The elevation is significantly greater in elderly patients. Administration of OPS can be considered safe for young and middle-aged patients with normal renal function; however, it should be used with caution in elderly patients, even in those with normal CCR and serum creatinine values.

The aim of this study was to determine the prevalence of autoimmune thyroid disease and the risk of miscarriage in autoimmune thyroid antibody (ATA)-positive women. Eight hundred seventy-six subjects completed the study, and 12.3% were thyroid antibody-positive (4.5% tested positive for both thyroid peroxidase antibody [TPO-Ab] and thyroglobulin autoantibody [Tg-Ab], 4.79% were TPO-Ab-positive only, and 3.1% were Tg-Ab-positive only). Fifty percent of the ATA-positive women and 14.1% of the ATA-negative group had a history of spontaneous abortion. Forty-eight of the ATA-positive women developed postpartum autoimmune thyroid dysfunction (PATD). Of these, 50% had hypothyroidism alone, 31.3% had transient hyperthyroidism followed by hypothyroidism, and 18.8% had transient thyrotoxicosis alone. Of the 48 PATD subjects, 12.5% developed persistent hypothyroidism. None of the ATA-negative women developed any form of thyroid dysfunction. The thyroid-stimulating hormone (TSH) levels in the ATA-positive group were significantly higher than those in the ATA-negative group, and only the ATA-positive women with a history of abortion had significantly higher TSH and lower free thyroxine (FT4) concentrations than the other subgroups. The results revealed a 5.5% prevalence rate for PATD in the study population. In addition to TPO-Ab, Tg-Ab is a useful marker for autoimmune thyroiditis.

Abstract. The present study has been conducted to quantify and compare the capacity of gas exchange in patients with type 2 diabetes mellitus (DM) and healthy controls and also to investigate the effects of various factors on alveolar capillary permeability. A total of 37 subjects, 25 patients with DM and 12 healthy controls were recruited for the study. All the participants were evaluated with simple spirometric tests and simple breath carbonmonoxide (CO) diffusion test (DLCO). The ratio of DLCO value to the alveolar ventilation (VA) was used to assess alveolar membrane permeability. Diabetic patients were also evaluated in detail with respect to degenerative diabetic complications including the presence of microalbuminuria, advanced nephropathy, sensorial and autonomic neuropathy, retinopathy, hypertension and macrovascular disease. The results of simple spirometric tests which determined lung capacity were similar in the diabetic patients and the healthy controls. Ratio of DLCO/VA, which determines alveolar membrane permeability, revealed statistically significant decline in pulmonary gas exchange in the diabetic group (p: 0.037). Pearson correlation analysis revealed statistically significant correlation between duration of diabetes mellitus, age and urinary albumin excretion with p: 0.001; p: 0.036; p: 0.023 respectively). This study demonstrated the decreased alveolar gas exchange capacity in diabetic patients compared with healthy controls. Detrimental effects of DM on alveolar capillaries were found to be correlated with age, duration of DM and urinary albumin excretion. Microalbuminuria was the only significant predictor of DLCO/VA.

This is a retrospective study to compare the criteria for diagnosis of gestational diabetes mellitus (GDM) by the National Diabetes Data Group (NDDG), and Carpenter and Coustan criteria, and to study the outcome of GDM when diagnosed by the more sensitive criteria. Six hundred and sixty-two pregnant women were included in this study from the medical records between September 1998 and April 2001. GDM was positive in 6.50% of patients according to Carpenter and Coustan and in 4.08% of patients according to NDDG criteria. Women with GDM were older, had higher fasting and glucose challenge test (GCT) glucose levels, and fetal weight than the normal women. Hypoglycemia was observed only in one infant. Regarding pre-term delivery and pre-eclampsia, there was no significant difference between the groups. Age, delivery week and fetal weight of patients who had caesarian delivery were significantly higher than spontaneous vaginal delivery. Prevalence of macrosomia in GDM group was higher than in the normal group. There was a significant correlation between the macrosomia and number of positive blood glucose values during OGTT. In multivariate analyses, fasting, GCT and second hour OGTT blood glucose levels, mean parity, and delivery week were independent risk factors for fetal weight. Carpenter and Coustan criteria is more sensitive than the NDDG criteria and women with GDM had a higher frequency of macrosomia and the frequency of macrosomia increases by the number of positive blood glucose levels during OGTT. Tight glycemic control might decrease the prevalence of caesarian delivery, pre-eclampsia, pre-term delivery and hypoglycemia of the infant.

OBJECTIVE -To determine the prevalence of diabetes and glucose intolerance and their relationship with risk factors in Adana, a southern province of Turkey, where risk factors are more prominent, probably because of social and economic reasons. RESEARCH DESIGN AND METHODS-The study population included 1,637 randomly selected adults aged 20 -79 years. Diagnosis of diabetes was based on plasma glucose values using the 1999 diagnostic criteria recommended by the World Health Organization.RESULTS -The crude prevalence of diabetes was 12.9% in men and 10.9% in women (P ϭ 0.207). Total prevalence of diabetes was 11.6%. The screening process identified previously undiagnosed diabetes in 4.2% of individuals and impaired glucose homeostasis (consisting of impaired glucose tolerance and impaired fasting glucose) in an additional 4.3% of subjects. The prevalence of hypertension was 26.4% among men and 36.6% among women (P Ͻ 0.0001). Total prevalence of hypertension was 32.9%, and prevalence of obesity was 43.4%. Age, sex, BMI, waist circumference, hypertension, family history of diabetes, and triglycerides were independently associated with diabetes.CONCLUSIONS -The prevalence of diabetes in Adana is higher than expected in both urban and rural areas. Obesity and hypertension also seem to be common metabolic disorders in this area. Age, hypertension, obesity, high triglyceride level, and family history of diabetes are independently associated with diabetes. Therefore, primary prevention through lifestyle modifications may have a critical role in the control of diabetes. Diabetes Care 26:3031-3034, 2003T ype 2 diabetes is recognized as a major global health problem, and its prevalence has been rising around the world (1). Individuals with diabetes have an increased risk of developing significant end-organ damage such as retinopathy, nephropathy, neuropathy, and cardiovascular disease (2). Tight glucose control delays many of these complications in patients with diabetes. Typically, it has been an asymptomatic disease for many years and about half of diabetic individuals are unrecognized (3). Type 2 diabetes is usually only recognized 5-12 years after hyperglycemia develops (4).The prevalence of diabetes varies widely between populations, reflecting differences in both environmental influences and genetic susceptibility (5). In Turkey, there have been a number of population-based studies of diabetes prevalence, and screening programs started in the 1940s. Nearly 1 million subjects have been screened to date, but because of different methodologies and lack of standardization between studies, considerable variations in diabetes prevalence have been reported, even in the same area (6 -8).The objective of this study was to determine the prevalence of diabetes and glucose intolerance and their relationship with risk factors in Adana, a southern province of Turkey, where risk factors are more prominent, probably because of social and economic reasons. RESEARCH DESIGN AND METHODS -The study was conducted in 18 (9 urban and 9 rural)...