Showing papers by "Anny H. Xiang published in 2004"
TL;DR: It is demonstrated that changes in SA in a number of type 2 diabetic cohorts serve as a quantitative indicator of improvements in insulin sensitivity obtained during TZD treatment, whereas changes in total serum adiponectin levels do not correlate well at the individual level.
1,150 citations
TL;DR: Among young Hispanic women at high risk for type 2 diabetes, the Pro12Ala variant of the PPAR-gamma receptor gene did not explain the failure of approximately 1/3 of subjects to increase their insulin sensitivity when placed on troglitazone at a dose of 400 mg/day.
Abstract: OBJECTIVE —We have tested whether the Pro12Ala variant of the peroxisome proliferator–activated receptor (PPAR)-γ nuclear receptor involved in thiazolidinedione (TZD) action accounted for the failure of troglitazone to increase insulin sensitivity in nondiabetic Hispanic women with previous gestational diabetes treated in the Troglitazone in Prevention of Diabetes (TRIPOD) study. RESEARCH DESIGN AND METHODS —Ninety-three women assigned to troglitazone had intravenous glucose tolerance tests at randomization and after 3 months of treatment with troglitazone, 400 mg/day, and were genotyped for the Pro12Ala variant of the PPAR-γ gene. Subjects were divided into tertiles based on their change in minimal model insulin sensitivity ( S i ) during the first 3 months of troglitazone treatment. RESULTS —The mean changes in S i in the bottom, middle, and top tertiles of S i response were −0.21 ± 0.57, 0.91 ± 0.26, and 2.58 ± 1.32 min −1 per μU/ml · 10 −4 , respectively. Frequencies of the Ala/− genotype were 30, 22, and 26% in the same three tertiles ( P = 0.77). Analysis of phenotypes by genotype revealed only small differences between the Pro/Pro and Ala/− groups, respectively, in baseline S i (2.76 ± 0.19 vs. 2.33 ± 0.33 × 10 −4 min −1 per μU/ml; P = 0.27), the change in S i after 3 months of troglitazone treatment (1.19 ± 0.17 vs. 0.93 ± 0.30; P = 0.46), and the cumulative incidence of diabetes during a median follow-up of 30 months (13 vs. 17%; P = 0.66). CONCLUSIONS —Among young Hispanic women at high risk for type 2 diabetes, the Pro12Ala variant of the PPAR-γ receptor gene did not explain the failure of ∼1/3 of subjects to increase their insulin sensitivity when placed on troglitazone at a dose of 400 mg/day.
84 citations
TL;DR: The role of insulin resistance in the genesis of progressive beta-cell dysfunction during the evolution of type 2 diabetes is highlighted, and in high-risk Hispanic women, amelioration of insulin Resistance can stabilize glycemia at the time diabetes develops.
Abstract: The purpose of this study was to compare the impact of treating insulin resistance with a thiazolidinedione drug before vs. at the onset of diabetes on glucose levels and β-cell function. Nondiabetic Hispanic women of Mexican or Central American descent with prior gestational diabetes mellitus (GDM) were randomized to troglitazone (early intervention), 400 mg/d, or placebo (later intervention). Women who developed diabetes were placed on open-label troglitazone. Glucose tolerance, insulin resistance, and β-cell function were measured at randomization, at the diagnosis of diabetes, and 8 months post trial to determine the long-term impact of the two treatment strategies on glucose levels and β-cell function. During a mean follow-up of 4.3 yr between baseline and posttrial tests, glucose tolerance (oral glucose tolerance test glucose area, P = 0.04) and insulin resistance (MINMOD SI, P = 0.02) worsened more in women randomized to late intervention (n = 69) than to early intervention (n = 57). Insulin secret...
54 citations
TL;DR: The majority of predictors were not modifiable, relating to obstetric history, maternal age and diabetes severity, and possible modifiable interventions to avoid/improve labor induction, and decrease birth weight and maternal weight gain might decrease risk of Cesarean delivery.
Abstract: Objectives: To identify independent risk factors for Cesarean delivery in women with pregnancy complicated by diabetes.Methods: Retrospective analysis of pregnancies from 5735 diabetic women delivering liveborn infants. Maternal demographic, medical, obstetric historical factors and index pregnancy obstetric, glycemic and neonatal outcome parameters were evaluated for association with Cesarean delivery after a trial of labor. Individual risk factors were analyzed for association by χ2and ANOVA. Independent predictors of Cesarean delivery and adjusted relative risk (RR) were identified by stepwise logistic regression.Results: Trial of labor waspermitted in 90.8% and 59.4% of women without (n=4643) and with prior Cesarean delivery (n=1092) and was successful in 85.2% and 56.9%, respectively. Eleven independent predictors were found. Five were related to obstetric history and maternal age: prior Cesarean delivery (RR 5.34, 95% CI 3.94–7.25), no prior live birth (RR 3.17, 95% CI 1.98–5.07), no prior vaginal d...
20 citations
1 citations