OBJECTIVE: To compare the effects of glimepiride and metformin on vascular reactivity, hemostatic factors and glucose and lipid profiles in patients with type 2 diabetes. METHODS: A prospective study was performed in 16 uncontrolled patients with diabetes previously treated with dietary intervention. The participants were randomized into metformin or glimepiride therapy groups. After four months, the patients were crossed over with no washout period to the alternative treatment for an additional four-month period on similar dosage schedules. The following variables were assessed before and after four months of each treatment: 1) fasting glycemia, insulin, catecholamines, lipid profiles and HbA1 levels; 2) t-PA and PAI-1 (antigen and activity), platelet aggregation and fibrinogen and plasminogen levels; and 3) the flow indices of the carotid and brachial arteries. In addition, at the end of each period, a 12-hour metabolic profile was obtained after fasting and every 2 hours thereafter. RESULTS: Both therapies resulted in similar decreases in fasting glucose, triglyceride and norepinephrine levels, and they increased the fibrinolytic factor plasminogen but decreased t-PA activity. Metformin caused lower insulin and pro-insulin levels and higher glucagon levels and increased systolic carotid diameter and blood flow. Neither metformin nor glimepiride affected endothelial-dependent or endothelial-independent vasodilation of the brachial artery. CONCLUSIONS: Glimepiride and metformin were effective in improving glucose and lipid profiles and norepinephrine levels. Metformin afforded more protection against macrovascular diabetes complications, increased systolic carotid artery diameter and total and systolic blood flow, and decreased insulin levels. As both therapies increased plasminogen levels but reduced t-PA activity, a coagulation process was likely still ongoing.

OBJETIVOS: Determinar a prevalência do diabetes melito (DM) e da hiperglicemia de estresse (HE) em pacientes com infarto agudo do miocárdio (IAM) admitidos em unidade de emergência cardiológica. MÉTODOS: Análise retrospectiva de 2.262 pacientes com IAM, avaliando, além da prevalência de diabetes referido, o diagnosticado e a hiperglicemia de estresse. RESULTADOS: Apesar de referido em 12,1% dos pacientes (H: 10,7%, M: 15,8%), o DM ocorria efetivamente em 24,8% (H: 22,9%, M: 29,7%) e a HE em 13,6% (H: 14,3%, M: 11,7%) dos indivíduos dessa população. Portanto, alterações glicêmicas ocorreram em 37,4% dos indivíduos com IAM (H: 37,2%, M: 41,4%). Nos pacientes com DM, observou-se maior precocidade etária do IAM, maior prevalência de óbitos (DM: 20,7%, ND:13,8%, HE: 13,4%) e de procedimentos cirúrgicos (ND: 33,8%, HE: 18,0%, DM: 21,7%). CONCLUSÃO: A elevada prevalência de DM e hiperglicemia de estresse observada em nosso estudo indica que as alterações glicêmicas constituem um dos mais importantes fatores de risco para o IAM.

OBJECTIVES: To evaluate in our population the real prevalence of diabetes (DM) and stress hyperglycemia (HE) in patients with myocardial infarction (IAM) admitted in a cardiologic emergency unit. METHODS: A retrospective analysis of 2262 patients with AMI evaluating the prevalence of DM (referred and diagnosed) and stress hyperglycemia. RESULTS: Besides 12,1% of subjects were previously referred to be diabetic (men: 10.7% and women: 15.8%), diabetes was effectively diagnosed in 24,8% (M: 22,9%, W: 29,7%) and stress hyperglycemia in 13,6% HE of the patients (M: 14,3%, W: 11,7%) indicating that glycemic alterations were effectively observed in 37.2.% of the patients with IAM (M: 37,2%, W: 41,4%). In DM subjects IAM events occurred earlier, total intra-hospital mortality was higher (DM: 20.7%, ND: 13,8%, HE: 13,4%) and less surgical procedures were performed (ND 33.8%, DM: 21.7%, HE: 18.0%). CONCLUSION: The elevated DM and stress hyperglycemia prevalence observed in our study indicates that glycemic alterations is one of the most important risk factors for IAM.

A resposta da 17-hidroxiprogesterona (17OHP) ao estímulo agudo com um análogo do hormônio liberador de gonadotrofinas (GnRHa) e sua relação com a sensibilidade à insulina (SI) foi avaliada em 8 mulheres voluntárias normais e obesas (grupo N), com idades entre 24 e 40 anos (mediana de 29) e índice de massa corpóreo (IMC) entre 32,0 e 46,5kg/m² (mediana de 35,7) e 8 pacientes portadoras da síndrome dos ovários policísticos (grupo SOP) com idades entre 19 e 28 anos (mediana de 26) e IMC entre 30,1 e 40,1kg/m² (mediana de 35,8), submetidas a estímulo agudo com acetato de leuprolide, 10µg/kg SC e a teste de tolerância oral à glicose (TTOG). Observou-se aumento significativo da concentração de 17OHP, tanto no grupo N (1,5 vs. 2,9ng/mL; p= 0,023) quanto no grupo SOP (0,8 vs. 3,1ng/mL; p= 0,007), não havendo diferença significativa entre os grupos. A SI foi avaliada através da área sob a curva de insulina (ASCI) no TTOG. O grupo N apresentou ASCI significativamente menor que o grupo SOP (14.384 vs. 22.800µUI/mL/min, p= 0,04). Não houve correlação entre a concentração de 17OHP após estímulo e a ASCI.

The response of 17-hydroxyprogesterone (17OHP) to gonadotropin-releasing hormone analogue (GnRHa) acute stimulation and its relationship to insulin sensitivity (IS) were evaluated in 8 normal obese voluntary women (group N), aged 24 to 40 years (median 29) and body mass index (BMI) of 32.0 to 46.5kg/m² (median of 35.7), and 8 patients with polycystic ovary syndrome (group PCOS) aged 19 to 28 years (median of 26) and BMI of 30.1 to 40.1kg/m² (median of 35.8), submitted to an acute stimulation with leuprolide acetate 10µg/kg and to am oral glucose tolerance test. We observed a significant increase of 17OHP levels in group N (1.5 vs. 2.9ng/mL; p= 0.023) as well as in group PCOS (0.8 vs. 3.1ng/mL; p = 0.007), with no significant difference between both groups. The area under the curve of insulin (AUCI) was significantly less in the group N (14,384 vs. 22,800mUI/mL/min, p= 0,04). There was no correlation between 17OHP and the AUCI.