Abstract
BackgroundImpaired glucose regulation (IGR) is associated with detrimental cardiovascular outcomes such as cardiovascular disease risk factors (CVD risk factors) or intima-media thickness (IMT). Our aim was to examine whether these associations are mediated by body mass index (BMI), waist circumference (waist) or fasting serum insulin (insulin) in a population in the African region.MethodsMajor CVD risk factors (systolic blood pressure, smoking, LDL-cholesterol, HDL-cholesterol,) were measured in a random sample of adults aged 25–64 in the Seychelles (n = 1255, participation rate: 80.2%).According to the criteria of the American Diabetes Association, IGR was divided in four ordered categories: 1) normal fasting glucose (NFG), 2) impaired fasting glucose (IFG) and normal glucose tolerance (IFG/NGT), 3) IFG and impaired glucose tolerance (IFG/IGT), and 4) diabetes mellitus (DM). Carotid and femoral IMT was assessed by ultrasound (n = 496).ResultsAge-adjusted levels of the major CVD risk factors worsened gradually across IGR categories (NFG < IFG/NGT < IFG/IGT < DM), particularly HDL-cholesterol and blood pressure (p for trend < 0.001). These relationships were marginally attenuated upon further adjustment for waist, BMI or insulin (whether considered alone or combined) and most of these relationships remained significant. With regards to IMT, the association was null with IFG/NGT, weak with IFG/IGT and stronger with DM (all more markedly at femoral than carotid levels). The associations between IMT and IFG/IGT or DM (adjusted by age and major CVD risk factors) decreased only marginally upon further adjustment for BMI, waist or insulin. Further adjustment for family history of diabetes did not alter the results.ConclusionWe found graded relationships between IGR categories and both major CVD risk factors and carotid/femoral IMT. These relationships were only partly accounted for by BMI, waist and insulin. This suggests that increased CVD-risk associated with IGR is also mediated by factors other than the considered markers of adiposity and insulin resistance. The results also imply that IGR and associated major CVD risk factors should be systematically screened and appropriately managed.
Highlights
Impaired glucose regulation (IGR) is associated with detrimental cardiovascular outcomes such as cardiovascular disease risk factors (CVD risk factors) or intima-media thickness (IMT)
According to the criteria of the American Diabetes Association, IGR was divided in four ordered categories: 1) normal fasting glucose (NFG), 2) impaired fasting glucose (IFG) and normal glucose tolerance (IFG/Normal glucose tolerance (NGT)), 3) IFG and impaired glucose tolerance (IFG/IGT), and 4) diabetes mellitus (DM)
With regards to IMT, the association was null with IFG/NGT, weak with Impaired fasting glucose / impaired glucose tolerance (IFG/IGT) and stronger with DM
Summary
Impaired glucose regulation (IGR) is associated with detrimental cardiovascular outcomes such as cardiovascular disease risk factors (CVD risk factors) or intima-media thickness (IMT). There is a growing interest in identifying individuals in stages preceding overt DM in order to potentially prevent the occurrence of DM and associated complications. The majority of complications of DM are related to cardiovascular disease (CVD) and it is important to assess whether pre-diabetes stages are associated with detrimental vascular outcomes [2]. Pre-diabetes has been first described by the World Health Organization in 1980 as impaired glucose tolerance (IGT) [3]. In order to avoid the time-consuming and somewhat cumbersome measurement of 2-hour postload glucose concentrations (2hBG), the American Diabetes Association (ADA) proposed in 1997 to identify pre-diabetes as impaired fasting glucose (IFG), which relies on one fasting measurement only. The respective prognostic values of IFG and IGT to predict DM and CVD risk are still controversial [5,8,9,10,11]
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