Except where otherwise noted, this work is licensed under Creative Commons Attribution-NonCommercial 4.0 International License. Background: Obesity is associated with several chronic conditions such as atherosclerosis and hypertension. AcknowledgmentThe authors wish to acknowledge the Research Deputy of Saveh Islamic Azad University and Saveh Diabetes Support Association for their financial support and cooperation in implementing this project. Therefore, extracts of aerial parts of the plant were evaluated for hypoglycaemic activity in normoglycaemic and diabetic rats.
This study focusing on type 2 obese diabetic men indicates that serum adiponectin can be a predictor for insulin resistance. Serum Adiponectin Levels are Inversely Correlated with Insulin Resistance in Obese Men with Type 2 Diabetes. BackgroundSeveral different adipokines are involved in the etiology and occurrence of insulin resistance, systemic inflammation, and atherosclerosis (1, 2). DiscussionAlthough various studies have demonstrated a significant relationship between serum adiponectin levels and insulin resistance in obese type 2 diabetic subjects and patients with other obesity-related diseases (7, 8, 16), other studies have failed to observe this relationship (19, 23, 24). Reversal of obesity-related hypoadiponectinemia by lifestyle intervention: a controlled, randomized study in obese adolescents. The dysregulated adipose tissue: a connecting link between insulin resistance, type 2 diabetes mellitus and atherosclerosis. Plasma adiponectin concentrations predict insulin sensitivity of both glucose and lipid metabolism. Adiponectin in childhood and adolescent obesity and its association with inflammatory markers and components of the metabolic syndrome. Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome.
Circulating concentrations of the adipocyte protein adiponectin are decreased in parallel with reduced insulin sensitivity during the progression to type 2 diabetes in rhesus monkeys.
Adiponectin, insulin resistance, and C-reactive protein in postpubertal Asian Indian adolescents. Adiponectin in youth: relationship to visceral adiposity, insulin sensitivity, and beta-cell function. Serum Level of Adiponectin and Its Association with Insulin Sensitivity in Overweight Diabetic and Non-Diabetic Iranian Men. Decreased serum levels of adiponectin are a risk factor for the progression to type 2 diabetes in the Japanese Population: the Funagata study.
Plasma adiponectin levels are related to obesity, inflammation, blood lipids and insulin in type 2 diabetic and non-diabetic Trinidadians.
Type 2 diabetes mellitus is characterized by reduced postprandial adiponectin response: a possible link with diabetic postprandial dyslipidemia.
Correlation of the adipocyte-derived protein adiponectin with insulin resistance index and serum high-density lipoprotein-cholesterol, independent of body mass index, in the Japanese population.
Adiponectin is functionally active in human islets but does not affect insulin secretory function or beta-cell lipoapoptosis. Plasma adiponectin does not correlate with insulin resistance and cardiometabolic variables in nondiabetic Asian Indian teenagers. Relationship of adipokines and non-esterified fatty acid to the insulin resistance in non-diabetic individuals.
Type 2 diabetes in non-obese Indian subjects is associated with reduced leptin levels: study from Mumbai, Western India. Relationship of serum adiponectin with blood lipids, HbA1c, and hs CRP in type II diabetic postmenopausal women. Insulin resistance index values were calculated using measurements of fasting glucose and insulin levels.
The results might be useful for research in the field of lipid metabolism, obesity and diabetes. Some of these adipokines directly or indirectly affect insulin sensitivity and insulin secretion, and others regulate fat and glucose metabolism (3).
This study, confirming some of the published findings, identified a significant inverse relationship between fasting serum adiponectin levels and insulin resistance in obese type 2 diabetic patients. The adipokine adiponectin, through its anti-diabetic and anti-atherogenic effects, plays an important role in type 2 diabetics and metabolic syndrome patients (4, 5). Thus, consistent with the findings of previous reports, the findings of this study showed that adiponectin level can be used as a predictive index for insulin resistance in obese patients with type 2 diabetes.The prevalence of obesity has increased dramatically in recent years and is associated with several chronic diseases, such as coronary artery disease, hypertension, metabolic syndrome, and, in particular, type 2 diabetes (26).
In addition, a significant relationship was observed between fasting glucose and adiponectin levels (p = 0.005).
Conversely, a decline in plasma or serum levels of adiponectin due to genetic or environmental factors has been implicated in the development of diabetes and insulin resistance syndrome (6).
Unlike other adipokines such as TNF-α and resistin, which cause insulin resistance in obesity or type 2 diabetes, adiponectin expression is reduced in obese people and insulin-resistant animal models (7).
Adipose tissue, in addition to storing body fat reserves, secrets several cytokines and peptide hormones that play important roles in energy homeostasis and are implicated in some chronic diseases.
Thus, reduction in plasma adiponectin levels reduces insulin sensitivity and prompts the onset of diabetes in such animal models (8).Some studies have also indicated a relationship between adiponectin levels and body fat content in diabetic patients. Adiponectin, an anti-inflammatory adipokine, is abundantly secreted by adipose tissue and directly sensitizes body tissues to insulin.

A recent report showed an inverse relationship of serum adiponectin levels with fasting insulin levels and insulin resistance, and when BMI and percentage of body fat were reduced to normal levels in the studied patients, this relationship became insignificant (9). A decrease in levels of adiponectin due to genetic or hormonal factors has been strongly implicated in the development of insulin resistance, type 2 diabetes, metabolic syndrome, and other chronic diseases that are associated with obesity (6). However, other studies suggest an inverse relationship between adiponectin and insulin resistance that is independent of body fat content (10, 11). Surprisingly, although adipose tissue is the main source of adiponectin, research findings suggest that the blood level of adiponectin is reduced in obese or type 2 diabetics who have large reserves of fat tissue (7, 8). Reduction of adiponectin levels has been suggested to play a central role in the increased incidence of type 2 diabetes and insulin resistance syndrome (6). Cross-sectional and longitudinal studies have shown that lower levels of adiponectin are associated with increased incidence of type 2 diabetes (13, 14).
In this study, we showed that fasting adiponectin levels in type 2 diabetic patients has a significant inverse relationship with insulin resistance, indicating that reduced adiponectin in these patients is associated with increased insulin resistance.
The reduction of levels of this hormone also has been observed in other diseases related to insulin resistance, including coronary heart disease (15, 16) and hypertension (15, 17).Recent scientific evidences support serum adiponectin concentration as a predictive index for type 2 diabetes (18). Therefore, based on the findings of this study along with other research findings, it can be stated that the serum adiponectin level is a precise predictive index of insulin resistance in patients with type 2 diabetes. However, unlike the above findings, in a recent study no difference in adiponectin levels was observed between type 2 diabetic patients and healthy subjects (19). Previous published findings have shown that a low adiponectin level is associated with greater insulin resistance and higher prevalence of type 2 diabetes (23). It was found that the fasting plasma adiponectin level and adiponectin gene expression in diabetic and non-diabetic patients was similar, and adiponectin gene expression was independent of the degree of obesity and insulin sensitivity (19). Adiponectin levels are reduced in obese animal models, which reduces insulin sensitivity and prompts type 2 diabetes onset (8). Another recent study showed that the expression of adiponectin receptors is similar in skeletal muscle of diabetic and non-diabetic men (20). In addition, a significant inverse relationship between adiponectin and fasting glucose levels was observed in this study. The hexane extract caused no hypoglycaemic action in normal rats and failed to sustain an initial hypoglycaemic action in diabetic rats. Some studies also failed to find a significant relationship between adiponectin and fasting glucose levels (21). This indicates that a decrease in adiponectin concentration is associated with an increase in fasting glucose levels, which is the main determinant of type 2 diabetes in obese patients. In this regard, Burg and colleagues showed that increasing plasma levels of adiponectin, by injection of recombinant adiponectin, resulted in a temporary reduction in plasma glucose levels due to inhibited expression of liver gluconeogenesis enzymes in diabetic mice (27).
We have previously reported a lower level of serum adiponectin in diabetic women compared to healthy subjects (28).
In addition, levels of HbA1c, an indicator of glycemic control, showed a negative correlation with serum adiponectin levels (28).Research studies have shown that long-term treatment with adiponectin leads to improved insulin resistance in diabetic mice (27). Consistent with this, in the present study we observed a significant inverse relationship of adiponectin and its receptors with insulin resistance. These findings suggest that increasing levels of systemic adiponectin and its receptors could be used as a novel therapeutic treatment for insulin resistance, type 2 diabetes, and cardiovascular disorders that are associated with obesity (29). ObjectivesThe above review demonstrates the contradiction in previous research results regarding the relationship between plasma adiponectin levels and insulin resistance.
Hence, the present study was carried out to determine the relationship of adiponectin levels with insulin resistance, and glucose and insulin levels, in obese type 2 diabetic men.3.
Patients and MethodsThe protocol of this study was approved by the Saveh Branch of Islamic Azad University, Iran.
Forty-eight adult obese diabetic male patients (BMI ≥ 29) with an average age of 44 years and an average weight of 92 kg were selected at random to participate in this study.
Anthropometric parameters of studied subjects were initially measured and recorded at the Physiology Lab of Saveh Azad University, Iran. The height of participants was measured in the standing position without shoes, with shoulders against a wall. The weights of subjects were measured using a digital scale with a 100-g maximum error (Taiwan), with minimal clothing and without shoes. To calculate body mass index, the formula of body weight (kilograms) divided by height (meters) squared was used.
The subjects were asked to abstain from any sports or heavy physical activity for 2 days before blood sampling. To accurately measure metabolic variables, blood sampling was conducted after 12 to 14 hours overnight fasting. After 10 minutes complete rest in a sitting position, an 8-ml venous blood sample was taken from each individual’s left hand vein.
To measure fasting glucose levels, the standard enzymatic (glucose oxidase) method was used (Pars Azmoon, Iran). The major classifications are Type 1 diabetes which results from an autoimmune destruction of pancreatic beta cells and Type 2 diabetes which occurs because of the body's ineffective use of insulin, also known as insulin resistance (2). After centrifugation at 3000 rpm for 10 minutes, the separated serum was removed and maintained at -80°C until analysis. Adiponectin and insulin levels were measured using ELISA kits (Biovendor Company, Czech Republic, and Demeditec Diagnostics, Germany).

Insulin and its analogs are compulsory in the management of Type 1 diabetes and may be introduced in Type 2 therapy when glycaemic control is poorly managed. Insulin resistance for each individual was calculated by applying the fasting insulin and glucose concentrations to a standard insulin resistance assessment formula (25).
ResultsThe anthropometric, clinical, and biochemical profiles of the studied subjects are summarized in Table 1.In the present study, fasting serum adiponectin levels and insulin resistance were determined in obese male patients with type 2 diabetes.
In the case of Type 2 diabetic therapy, oral anti-diabetic medications frequently lose their efficacy in a number of patients (3) and some medications can present with moderate to severe adverse effects. Thus, a lower serum adiponectin level was associated with a higher level of insulin resistance.
Sulfonylureas and meglitinides can cause hypoglycaemia and weight gain (3); thiazolidinediones are reported to increase risk of cardiovascular events and liver toxicity (3), while biguanides such as metformin commonly cause lactic acidosis (5). Scientific studies have validated the efficacy of over 1200 plant species in the treatment of diabetes mellitus (6, 7). Herbs used as therapy are speculated to have minimal undesirable effects and may be helpful in managing the various complications of this disease which include retinopathy, nephropathy, neuropathy and cardiovascular disease (3, 8). Leaves were identified and authenticated by Mr Michael Lewis of the Botany Department and accession number 35403 received. The mixture was filtered using a cheese cloth, concentrated and frozen before placing on the freeze dry machine. Animals were housed in meshed metal cages and maintained under standard temperature of 25-30 A‚A?C, light and dark cycles of 12 hours.
The experimental protocol conformed to the guidelines for animal care and use of the institution. Blood glucose was recorded before dosing and then at 30-minute intervals for three hours following administration.
The Student's t-test was used to determine significance between the mean of the control and treatment groups. 2) showed no significant reduction of blood glucose concentration in fasted normoglycaemic rats. This effect, however, was not sustained as no further reduction in blood glucose was observed in week 3.
The preliminary screening of plant extracts in normoglycaemic rats is an established approach for determining glycaemic effects when there is normal pancreatic activity (18).
This was the approach in the present study as we investigated the hypoglycaemic activity of p alliacea extracts in normal and diabetic rats.
Therefore, for our study, aqueous and hexane extracts were prepared to determine the potential glycaemic outcome of different compounds across varying polarities and also to remain consistent with earlier studies which have reported pharmacological activities (24).
Our results challenge previously reported findings by Lores and Cires Pujol (14) which showed an aqueous extract producing a 60% decline in blood glucose levels in fasted mice.
It is important, however, to highlight that the contrasting glycaemic outcomes from our study versus that of Lores and Cires Pujol (14) may arise because of differences in sample preparation and conditions. A high sugar content of the extract at higher doses could explain the hyperglycaemia observed, however, further chemical analysis is required to confirm this. This therefore confirmed that both extracts of p alliacea do not exhibit hypoglycaemic activity in normoglycaemic rats. The lower dose of the aqueous extract was chosen because it produced the most notable response in the glucose loaded model (Fig. The higher dosage for the hexane extract was selected since it produced the most notable response in the glucose loaded model (Fig. This transient hypoglycaemic effect may be due in part to a reduction in the rate of intestinal glucose absorption or an increase in peripheral glucose utilization as this is commonly observed in the rodent models of streptozotocin-induced diabetic models (25). Further, several flavonoids including quercetin which are present in the leaves of p alliacea (20) have been shown to reduce intestinal glucose absorption (26-28) and one plausible explanation for the unsustained hypoglycaemic effect seen with our extract could be inefficient inhibition of the sugar transporter GLUT2 by these flavonoids (26). Furthermore, a hypergly-caemic effect was observed with the aqueous extract at high dose. These findings hold significant implications for the ethno-traditional use of p alliacea as a hypoglycaemic agent where it is used in an aqueous form.
Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.
Effects of hydromethanolic leaves extract of indigofera pulchra on blood glucose levels of normoglycemic and alloxan induced diabetic wistar rats.
Subchronic and acute preclinic toxicity and some pharmacological effects of the water extract from leaves of petiveria alliacea (Phytolaccaceae).
A critical review of the therapeutic potential of dibenzyl trisulphide isolated from Petiveria alliacea L (guinea hen weed, anamu).
Analysis of fetal and placental development in rats after administration ofhydroalcoholic extract from the root of petiveria alliacea L. Hypoglycemic of Canajus scarabaeoides in glucose overloaded and Streptozotocin-induced diabetic rats. Isolation of isoarborinol, isoarborinol acetate and isoarborinol cinnamate from the leaves.

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