bAcKGrOUND: Amelioration of insulin resistance could improve both glycaemic control and cardiovascular risk factors in patients with type 2 diabetes mellitus. Alpha-lipoic acid has been shown to improve insulin action after parenteral administration. ObJEctIVE: the aim of the study was to assess the effect of oral administration of alpha-lipoic acid on insulin sensitivity in patients with type 2 diabetes. DEsIGN: twelve patients (mean±sD; age 52.9±9.9 yrs; body mass index 33.9±7.4kg/m 2 ) were treated with oral alpha-lipoic acid, 600mg twice daily over a period of 4 weeks. twelve subjects with normal glucose tolerance served as a control group in terms of insulin sensitivity (Is). Is was measured by a 2h manual hyperinsulinaemic (insulin infusion rate-40mU/m 2 body surface area/min) euglycaemic (blood glucose kept at 5mmol/l) clamp technique and expressed as a glucose disposal rate (M) and insulin sensitivity index (IsI). rEsULts: At the end of the treatment period, Is of diabetic patients was significantly increased: M from 3.202±1.898 to 5.951±2.705mg/kg/min (mean±sD), p<0.01; and IsI from 4.706±2.666 to 7.673±3.559mg/kg/min per mIU/lx100 (mean±sD), p<0.05. the difference was not statistically significant between the Is of diabetic patients after alpha-lipoic acid therapy and control subjects cONcLUsION: short-term oral alpha-lipoic acid treatment increases peripheral insulin sensitivity in patients with type 2 diabetes mellitus.

The aim of the present study was to evaluate the effect of three different combinations of hormone replacement therapy (HRT) on insulin secretion, peripheral insulin sensitivity, serum lipid levels and parameters of oxidative stress. Seven type II diabetic women of mean age 55.4 +/- 4.7 years, who had been menopausal for an average of 5 years, were enrolled in the study. Phases of insulin secretion--first (FPIS) and second (SPIS)--and the area under the curve (AUC) for insulin secretion were studied during an intravenous glucose tolerance test (IVGTT). Insulin sensitivity was determined using the manual euglycemic-hyperinsulinemic clamp technique. Three different HRT combinations were applied consecutively for 3-month periods: estradiol valerate plus cyproterone acetate (Climen); transdermal 17 beta-estradiol (System TTS 50) plus dydrogesterone (Duphaston) 10 mg daily for 10 days a month; oral 17 beta-estradiol plus dydrogesterone (Femoston) for 14 days a month. A group of nine women with normal glucose tolerance (according to World Health Organization criteria during a 75-g oral glucose tolerance test (OGTT)), of mean age 50.1 +/- 8.2 years and mean body mass index 24.60 +/- 2.01 kg/m2, were also studied, and served as a control group. Insulin secretion improved significantly after Climen: FPIS increased by 16% and SPIS by 44%. Insulin sensitivity increased by 50% after Systen TTS 50 + Duphaston; fasting hyperinsulinemia was normalized and total antioxidant capacity of the serum (TAOCS) was significantly raised (p < 0.01). Femoston led to an increase in insulin sensitivity (by 23%) and in TAOCS (p < 0.05), while fasting hyperinsulinemia remained unchanged. HRT should be prescribed in type II diabetic postmenopausal women because of its favorable effect on existing pathophysiological defects. Cyproterone acetate should be preferred in cases with a predominant beta-cell insulin secretion defect, while dydrogesterone in combination with a transdermal estrogen should be recommended in cases with leading insulin resistance.

With an increasing prevalence of metabolic syndrome (MS) early detection and timely management of cardiometabolic risk factors are crucial to prevent complications such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). There are no defined treatments for MS apart from addressing each of its components such as insulin resistance, hyperinsulinaemia, obesity, dyslipidaemia, hypertension and hyperglycaemia. The mechanism responsible for diabetes prevention is related to improved insulin sensitivity and reduced hyperinsulinaemia. Metformin has been established as a first-line therapy in patients with T2DM because it counteracts hyperinsulinaemia and hyperglycaemia and reduces cardiometabolic risk. Although the cardiovascular benefits with metformin are clearly demonstrated in diabetic and prediabetic patients, the efficacy of metformin in reducing cardiometabolic risk factors in persons with MS and normal glucose tolerance (NGT) remains inconclusive. This review focuses on the evidence base considering the therapeutic potential of metformin in NGT persons with MS representing a high-risk population for development of T2DM and CVD.

The aim of the present study was to evaluate the effect of three different combinations of hormone replacement therapy (HRT) on insulin secretion, peripheral insulin sensitivity, serum lipid levels and parameters of oxidative stress. Seven type II diabetic women of mean age 55.4 +/- 4.7 years, who had been menopausal for an average of 5 years, were enrolled in the study. Phases of insulin secretion--first (FPIS) and second (SPIS)--and the area under the curve (AUC) for insulin secretion were studied during an intravenous glucose tolerance test (IVGTT). Insulin sensitivity was determined using the manual euglycemic-hyperinsulinemic clamp technique. Three different HRT combinations were applied consecutively for 3-month periods: estradiol valerate plus cyproterone acetate (Climen); transdermal 17 beta-estradiol (System TTS 50) plus dydrogesterone (Duphaston) 10 mg daily for 10 days a month; oral 17 beta-estradiol plus dydrogesterone (Femoston) for 14 days a month. A group of nine women with normal glucose tolerance (according to World Health Organization criteria during a 75-g oral glucose tolerance test (OGTT)), of mean age 50.1 +/- 8.2 years and mean body mass index 24.60 +/- 2.01 kg/m2, were also studied, and served as a control group. Insulin secretion improved significantly after Climen: FPIS increased by 16% and SPIS by 44%. Insulin sensitivity increased by 50% after Systen TTS 50 + Duphaston; fasting hyperinsulinemia was normalized and total antioxidant capacity of the serum (TAOCS) was significantly raised (p < 0.01). Femoston led to an increase in insulin sensitivity (by 23%) and in TAOCS (p < 0.05), while fasting hyperinsulinemia remained unchanged. HRT should be prescribed in type II diabetic postmenopausal women because of its favorable effect on existing pathophysiological defects. Cyproterone acetate should be preferred in cases with a predominant beta-cell insulin secretion defect, while dydrogesterone in combination with a transdermal estrogen should be recommended in cases with leading insulin resistance.

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Treatment of the metabolic syndrome (MS) is essential for prevention of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). The purpose of this open-label prospective one year observational clinical study was to examine the effects of metformin 2.55 ± 0.3 g/d on body weight management and markers of the MS in normal glucose tolerant persons with hyperinsulinaemia. Body weight was reduced by 6.8% at 6 months and by 11.1% at 1 year. The body weight reduction was 7.2 ± 3.4 kg at 6 months and 11.7 ± 4.7 kg (mean ± SD) at 1 year. We found a significant correlation of reduction of body weight at 1 year with initial body weight, body mass index, waist circumference and homeostasis model assessment of insulin resistance (HOMA-IR), all p < 0:001. At 1 year of metformin treatment HOMA-IR, total cholesterol, low-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure were significantly reduced, all p < 0:001 and high-density lipoprotein cholesterol was significantly increased, p = 0:004. Our study shows that treatment with metformin alone, without intensive diet and physical activity, could reduce visceral obesity, insulin resistance, dyslipidaemia and arterial hypertension and supports the hypothesis that it could be applied for prevention of T2DM and CVD.