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Aims/hypothesis The aim of this study was to examine the relationship between glycaemic control and hospitalisation for heart failure in patients with type 2 diabetes. Methods Patients included in the Swedish National Diabetes Register (NDR) during 1998-2003 were followed until hospitalisation for heart failure, death or 31 December 2009. Unadjusted and adjusted incidence rates for heart failure were estimated by Poisson regression and relative risk was estimated by Cox regression. Results In 83,021 patients with type 2 diabetes, 10,969 (13.2%) were hospitalised with a primary or secondary diagnosis of heart failure during a mean follow-up of 7.2 years. The incidence increased by male sex (p<0.001), older age (p < 0.001) and longer diabetes duration (p < 0.001). In Cox regression adjusting for risk factors of heart failure the HR per each percentage unit higher HbA 1c (10 mmol/mol) for heart-failure hospitalisation was 1.12 (95% CI 1.10, 1.14).

Ghrelin is associated with glucose homeostasis but its’ possible relevance with glucose levels in physiological and pathological conditions has so far been poorly investigated. The aim of the present study was to evaluate circulating ghrelin levels in prediabetic and diabetic patients in basal conditions and in response to oral glucose tolerance test (OGTT). A total of 90 male adults aged 40 – 73 years old were enrolled in our study. Fasting and postprandial plasma ghrelin, insulin and glucose levels were measured at 0, 60, 120 and 180 min following an OGTT in 40 patients with type 2 diabetes mellitus (T2DM), 20 with impaired glucose tolerance (IGT) and 30 controls. Incremental and total area under response curve were determined and calculated for glucose, insulin and ghrelin. Fasting plasma ghrelin concentrations were significantly lower in the T2DM group than IGT and control group patients (p<0.01) but not between healthy subjects and IGT group (p=0.746). In the diabetics’ group ghrelin levels showed a statistically significant negative correlation with insulin and a positive correlation with HbA1c and glucose. At all time points after the OGTT ghrelin concentrations were significantly lower in the T2DM group compared to IGT group and controls. Plasma ghrelin concentrations are lower in male diabetic patients at the fasting state and remain lower at all time points after an OGTT while minor differences were found between normal and IGT subjects. Ghrelin might play a role in insulin and glucose metabolism in diabetic patients but not in patients with IGT.

Purpose: The aim of the present study was to evaluate circulating plasma obestatin levels and its’ secretory dynamics in subjects with impaired glucose tolerance (IGT) as well as in patients with type 2 diabetes (T2DM) in basal conditions and in response to oral glucose tolerance test (OGTT). Furthermore we wish to investigate possible associations between obestatin and several metabolic parameters in T2DM. Methods: The study comprised 73 male adults aged 40 - 72 years (31 with T2DM, 17 with IGT and 25 control healthy individuals). Plasma obestatin, insulin and glucose levels were measured at 0, 60, 120 and 180 min following an OGTT. Total area under response curve was determined and calculated for glucose, insulin and obestatin. Results: Significant differences in the kinetics of obestatin levels during OGTT were observed only in the control group (p=0.012), where specifically shown that plasma obestatin concentrations decreased significantly at 120΄ (p=0.005) and 180΄ (p=0.050) compared to 60΄. Plasma obestatin concentrations were significantly lower in the T2DM group compared to controls at baseline (p<0.001) and at 60΄ following OGTT (p=0.007). At 60΄, plasma obestatin concentrations were also significantly lower in the T2DM compared IGT (p=0.044). In addition, both AUC and nadir obestatin levels were lower in T2DM compared to controls (p=0.039 and p=0.001 respectively). In T2DM basal obestatin levels showed a statistically significant positive correlation with triglycerides, fasting insulin, HOMA–IR, HOMA2–IR, HΟΜΑ–β and a negative correlation with Quicki and Matsuda Index. Similarly in the IGT group, basal obestatin levels showed a positive correlation with fasting insulin, HOMA–β and HOMA2–IR. Conclusion: We observed significantly lower plasma obestatin levels in patients with T2DM and those with IGT compared to normoglycemic individuals both in basal conditions and during an OGTT. Moreover, significant associations of obestatin with several metabolic profile indices were also found in T2DM.