Background: The effect of pravastatin on insulin resistance (IR) is controversial and poorly studied in prediabetes. Methods: This study was performed in hyperglycemic patients at Saint Carollo Hospital from January 1, 2013 to December 31, 2015. Among them, we selected 40 patients (24 prediabetes and 16 new onset diabetes [NOD]) who had been treated with pravastatin 20 mg daily for 2 or 4 months and in whom fasting insulin and fasting glucose had been measured before and after administration of pravastatin. IR was defined as a fasting insulin level ≥ 12.94 μU/mL, homeostasis model for IR (HOMA-IR) ≥ 3.04 or quantitative insulin sensitivity check index (QUICKI) ≤ 0.32. Results: Pravastatin treatment decreased total cholesterol and low-density lipoprotein cholesterol levels by 25.2% and 32.3% respectively (P = 0.000 for all), but did not affect fasting insulin level, HOMA-IR, or QUICKI in total, prediabetes, and NOD groups. Prevalence of IR was significantly different between prediabetes and NOD groups both before and after pravastatin treatment (0% versus 37.5%, P = 0.001), but pravastatin treatment did not affect the prevalence of IR in the prediabetes or NOD group. Fasting glucose level was not significantly different before and after pravastatin treatment in prediabetes (106.8 ± 6.4 mg/dL versus 103.8 ± 8.4 mg/dL, P = 0.223) but was significantly different in the NOD group (171.5 ± 혈당이 높은 환자에서 Pravastatin이 인슐린 저항성에 미치는 영향 정용진, 김정민, 장승재, 방준희, 정영곤, 김성택, 강순형, 최종인, 김수성, 강미연

Background: Elderly patients usually have comorbid and poor general conditions. They are more likely to have complex coronary lesions with cardiac dysfunction. Percutaneous coronary intervention (PCI) in octogenarians remains controversial. In this study, we determined the safety after PCI for octogenarians and their younger counterparts with coronary artery disease. Methods: We reviewed 1,057 patients (110 octogenarians vs. 947 younger counterparts) who underwent PCI for coronary artery disease at Saint Carollo Hospital. We analyzed the baseline characteristics, angiographic findings, in hospital mortality, and post procedural complications between the two groups. Results: The mean ages of octogenarians and younger counterparts were 83.1±4.5 years and 62.6±10.3 years, respectively. The octogenarian group had a significantly (p<0.001) higher ratio of female patients compared to their younger counterpart group (57.3% vs. 27.5%). However, the octogenarian group had a significantly (p=0.035) lower ratio of patients with history of diabetes mellitus compare to their younger counterpart group (22.7% vs. 32.6%). Incidence of acute myocardial infarction in octogenarians was significantly (p<0.001) higher than that in the younger counterparts (43.7% vs. 18.0%). There was no significant difference in admission duration, major complication, or in-hospital mortality between two groups. Conclusion: Our results revealed that hospital mortality and incidence of major complications in octogenarians who underwent invasive PCI were not higher than those in their younger counterparts, suggesting that PCI could be safely used in patients aged 80 years or older. However, long-term follow-up data are needed.

ABSTRACT:A Miniature schnauzer (12 years old, neutered male) was referred for lethargy, anorexia, and oral bleeding. On initial evaluation, severe hyperglycaemia (blood glucose concentration of 34.9 mmol/l), ketonuria, systemic inflammation (fever, panting, left-shift neutrophilia, and a high C-reactive protein level of 980.97 nmol/l, abnormal pancreatic lipase immunoreactivity, and periodontitis were found. With consideration of possible insulin resistance, blood glucose (BG) levels were monitored using a portable glucose meter (q 1-3 h) and a continuous glucose monitoring system (CGMS) for 72 h (three consecutive trials); intensive insulin therapy was initiated using regular insulin (2.2 IU/kg intravenously). The insulin doses needed, based on the nadir, peak, and duration of insulin action from a traditional intermittent glucose curve were higher than those based on the CGMS results. Meanwhile, transient hyperglycaemic and hypoglycaemic periods, occurring between the intermittent measurements, were easily identified with the CGMS. Therefore, insulin resistance and the Somogyi phenomenon are less likely to occur with use of the CGMS than with intermittent BG measurements. By comparing data from a CGMS to those from an intermittent portable BG measurement system, this case report emphasises the importance and usefulness of a CGMS.