In patients with Type 2 diabetes, the risk of progression of nephropathy increases significantly with HbA(1c) variability, independently of the influence of updated mean HbA(1c) .

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OBJECTIVEThe glycation gap (the difference between measured A1C and the value predicted by regression on fructosamine) is stable and is associated with microvascular complications of diabetes but has not hitherto been estimated within a clinically useful time frame. We investigated whether two determinations 30 days apart suffice for a reasonably reliable estimate if both A1C and fructosamine exhibit stability.RESEARCH DESIGN AND METHODSWe studied 311 patients with type 1 or type 2 diabetes for whom simultaneous measurements of A1C and serum fructosamine had been made on at least two occasions separated by 1 month (t0 and t1). Glycemia was deemed stable if A1C(t1) – A1C(t0) and fructosamine(t1) − fructosamine(t0) were both less than their reference change values (RCVs). Instantaneous glycation gaps [gg(t0) and gg(t1)] and their mean (GG), were calculated using the data from all stable patients for the required regression.RESULTSStable glycemia was shown by 144 patients. In 90% of unstable case subjects, a change in medication was identified as the cause of instability. Among 129 stable patients with an average of eight gg determinations prior to t0, GG correlated closely with the mean of these prior determinations (r2 = 0.902, slope 1.025, intercept −0.038).CONCLUSIONSThe glycation gap can be calculated reliably from pairs of A1C and fructosamine measurements taken 1 month apart if these measurements satisfy the RCV criteria for glycemic control.

Este trabajo tiene como objetivo caracterizar el sitio Cañada Seca-1, un entierro múltiple (NMI=24) localizado en el valle del Atuel y fechado en ca. 1500 años AP, a través de la integración de diferentes líneas de evidencia. A partir de este registro se discuten las interpretaciones en torno a la presencia de cultígenos y sus implicancias para la subsistencia humana en un área caracterizada tradicionalmente como el límite de la dispersión agrícola sudamericana, ca. 2200 años AP. Los resultados destacan que los individuos inhumados en el sitio no habrían desarrollado una estrategia fundamentalmente agrícola, aunque el maíz formó parte de su dieta. Además, la nueva información sobre los comportamientos mortuorios en la zona del valle del Atuel, ofrece evidencias tanto sobre movilidad como sobre el uso de tecnologías utilitarias (líticas) y no utilitarias (ornamentos líticos y malacológicos) que trascendieron la vida cotidiana y los acompañaron en la muerte.

To determine the mechanism responsible for deficient carbohydrate metabolism in patients with insulinoma, we studied three affected patients and seven normal controls using the hyperglycaemic clamp method (8.4 mmol/l) with the BIO-STATOR (GCIIS). In insulinoma patients, the amount of glucose necessary to reach the hyperglycaemic clamp was less than that required in normal controls (6.19 + 1.19 mg/min/ kg vs. 9.95 + 0.53 mg/min/kg) (p < 0.05). There was no significant difference in metabolized glucose (M) in the stable phase of the hyperglycaemic clamp; however, the M/IRI in this phase was less in those with insulinoma (7.9 + 0.50) than in controls (22.26 + 4.14) (p < 0.05). There was no difference in beta cell secretory response to hyperglycaemic stimulus (defined as the increase in the concentration of C-peptide from the basal state to the stable phase of the hyperglycaemic clamp) between the two groups. Hepatic insulin extraction was significantly lower in patients with insulinoma than in normal controls (+0.72 + 0.07 vs. +0.85 + 0.01). Finally, the ratios of fractional turnover of glucose (K/IRI); glucose clearance/IRI and total rate of elimination of glucose from the extracellular pool/IRI were also all lower in patients with insulinoma than in controls (p < 0.05). These data support the conclusion that deficient glucose metabolism seen in these patients is not related to a lack of response to glucose on the part of normal or neoplastic islet tissue. The lesser quantity of infused glucose needed to reach the clamp in patients with insulinoma; the reduced ratio of glucose disappearance to immunoreactive insulin; and the reduced rate of glucose metabolism with respect to immunoreactive insulin levels, all suggest the existence of "insufficient hormonal activity", probably related to hypersecretion of proinsulin or proinsulin fragments displaying cross-reactivity with insulin, but with lesser biological activity. A further possibility is the decrease of the insulin's receptor number by the patients' hyperinsulinemia.