Coronary artery disease (CAD) is the major cause of mortality and morbidity in patients with type 2 diabetes. But utility screening diabetes for asymptomatic CAD controversial.

OBJECTIVE—To assess the prevalence and clinical predictors of silent myocardial ischemia in asymptomatic patients with type 2 diabetes to test effectiveness current American Diabetes Association screening guidelines. RESEARCH DESIGN AND METHODS—In Detection Ischemia Asymptomatic Diabetics (DIAD) study, 1,123 diabetes, aged 50–75 years, no known or suspected coronary artery disease, were randomly assigned either stress testing 5-year follow-up only. The 522 randomized was assessed by...

Although insulin stimulates protein synthesis and inhibits breakdown in skeletal muscle vitro, the actual contribution of these actions to its anabolic effects man remains unknown. Using forearm perfusion method together with systemic infusion L-[ring-2,6-3H]phenylalanine L-[1-14C]leucine, we measured steady state amino acid exchange kinetics across seven normal males before response a 2-h intraarterial insulin. Postabsorptively, disposal (Rd) phenylalanine (43 +/- 5 nmol/min per 100 ml...

Hyperglycemia is common and associated with markedly increased mortality rates in patients hospitalized acute coronary syndromes (ACS). Despite the fact that several studies have documented this association, hyperglycemia remains underappreciated as a risk factor, it frequently untreated ACS patients. This large part due to limitations of prior studies, remaining critical gaps our understanding relationship between poor outcomes. The main objective present statement summarize current state...

Insulin increases glucose disposal into muscle. In addition, in vivo insulin elicits distinct nitric oxide synthase-dependent vascular responses to increase total skeletal muscle blood flow and recruit capillaries (by relaxing resistance terminal arterioles, respectively). the current study, we compared temporal sequence of metabolic a 30-min physiological infusion (3 mU · min−1 kg−1, euglycemic clamp) or saline rat vivo. We used contrast-enhanced ultrasound continuously quantify...

The metabolic syndrome is a complex clustering of defects associated with physical inactivity, abdominal adiposity, and aging. Purpose: To examine the effects exercise training intensity on visceral fat (AVF) body composition in obese women syndrome. Methods: Twenty-seven middle-aged (mean ± SD; age = 51 9yr mass index 34 6 kg·m−2) completed one three 16-wk aerobic interventions: (i) no-exercise (Control): seven participants maintained their existing levels activity; (ii) low-intensity...

We examined the effects of inhibiting nitric oxide synthase with N ω -nitro-l-arginine-methyl ester (l-NAME) on total hindlimb blood flow, muscle microvascular recruitment, and glucose uptake during euglycemic hyperinsulinemia in vivo rat. used two independent methods to measure perfusion. In one group animals, recruitment was measured using metabolism exogenously infused 1-methylxanthine (1-MX), a second contrast-enhanced ultrasound (CEU) used. Limb by arterial-venous concentration...

To elucidate the acute metabolic actions of insulin-like growth factor I (IGF-I), we administered a primed (250 micrograms/kg), continuous (5 micrograms/kg.min) infusion human recombinant (Thr 59) IGF-I or saline to awake, chronically catheterized 24-h fasted rats for 90 min. was also infused while maintaining euglycemia (glucose clamp technique) and its effects were compared those insulin. caused twofold rise in levels 75-85% decrease plasma When alone given, glucose fell by 30-40 mg/dl (P...

We have previously shown that skeletal muscle capillaries are rapidly recruited by physiological doses of insulin in both humans and animals. This facilitates glucose delivery to muscle, thus augmenting uptake. In obese rats, insulin-mediated microvascular recruitment uptake diminished; however, this action has not been studied humans. Here we used contrast ultrasound measure blood volume (MBV) (an index recruitment) the forearm flexor muscles lean adults before after a 120-min...

OBJECTIVE—Despite the demonstrated benefits of glycemic control, patient acceptance basal/bolus insulin therapy for type 1 diabetes has been slow. We investigated whether a regimen involving rapid-acting, dry powder, inhaled could provide control comparable with subcutaneous regimen. RESEARCH DESIGN AND METHODS—Patients (ages 12–65 years) received twice-daily NPH and were randomized to premeal (n = 163) or regular 165) 6 months. RESULTS—Mean glycosylated hemoglobin (A1C) decreased comparably...

Despite intensive study, the relation between insulin’s action on blood flow and glucose metabolism remains unclear. Insulin-induced changes in microvascular perfusion, independent from effects total flow, could be an important variable contributing to metabolic action. We hypothesized that modest, physiologic increments plasma insulin concentration alter perfusion human skeletal muscle these can assessed using contrast-enhanced ultrasound (CEU), a validated method for quantifying by...

The short-term effects of growth hormone (GH) on skeletal muscle protein synthesis and degradation in normal humans are unknown. We studied seven postabsorptive healthy men (age 18-23 yr) who received GH (0.014 micrograms.kg-1.min-1) via intrabrachial artery infusion for 6 h. forearm amino acid glucose balances kinetics [( 3H]Phe [14C]Leu) were determined after 3 h the infusion. Forearm deep vein rose to 35 +/- ng/ml response GH, whereas systemic levels insulin, insulin-like factor I (IGF-I)...

Insulin inhibits proteolysis in human muscle thereby increasing protein anabolism. In contrast, IGF-I promotes anabolism principally by stimulating synthesis. As increases or decreases of plasma amino acids may affect turnover and also alter the muscle's response to insulin and/or IGF-I, this study was designed examine effects on during hyperaminoacidemia. We measured phenylalanine balance [3H]-phenylalanine kinetics both forearms 22 postabsorptive adults a continuous [3H] infusion....

Coronary artery disease (CAD) accounts for a large fraction of the morbidity, mortality, and cost diabetes. Recognizing this, nearly 10 years ago American Diabetes Association published consensus recommendation that clinicians consider risk factor–guided screening approach to early diagnosis CAD in both symptomatic asymptomatic patients. Subsequent clinical trial results have not supported those recommendations. Since prior statement, newer imaging methods, such as coronary calcium scoring...

Insulin-induced increases in blood flow are hypothesized to enhance overall glucose uptake by skeletal muscle. Whether the insulin-mediated changes associated with altered distribution and increased capillary recruitment muscle is not known. In present study, effects of insulin on hemodynamic parameters rat vivo were investigated. Mean arterial pressure, heart rate, femoral flow, hind leg vascular resistance, measured control euglycemic insulin-clamped (10 mU · min−1 kg−1) anesthetized rats....

An inhibitor of human liver glycogen phosphorylase a (HLGPa) has been identified and characterized in vitro vivo. This substance, [R-(R*, S*)]-5-chloro-N-[3-(dimethylamino)-2-hydroxy-3-oxo-1-(phenylmethyl)pr opyl]-1H-indole-2-carboxamide (CP-91149), inhibited HLGPa with an IC50 0.13 microM the presence 7.5 mM glucose. CP-91149 resembles caffeine, known allosteric inhibitor, that it is 5- to 10-fold less potent absence Further analysis, however, suggests caffeine are kinetically distinct....

Supraphysiological doses of insulin enhance total limb blood flow and recruit capillaries in skeletal muscle. Whether these processes change response to physiological hyperinsulinemia is uncertain. To examine this, we infused either saline (n = 6) or (euglycemic clamp, 3.0 mU · min−1 kg−1, n 9) into anesthetized rats for 120 min. Femoral artery was monitored continuously using a Doppler probe, muscle microvascular recruitment assessed by metabolism 1-methylxanthine (1-MX) contrast-enhanced...