2-hour Glucose Levels Research Articles

Role of prediabetes in stroke.

Stroke is one of the leading causes of death and probably the greatest cause of adult disability worldwide. Diabetes mellitus (DM) is a state of accelerated aging of blood vessels. Patients with diabetes have increased risk of stroke. Hyperglycemia represents a risk factor for poor outcome following stroke, and probably is just a marker of poor outcome rather than a cause. Lowering of blood glucose levels has not been shown to improve prognosis. Also, prevention of stroke risk among patients with DM is not improved with therapy for reduction of glucose levels. On the other hand, prediabetes, a metabolic state between normal glucose metabolism and diabetes, is a risk factor for the development of DM type 2 and subsequently for stroke. Several methods are known to identify prediabetes patients, including fasting plasma glucose levels, 2-hour post load glucose levels, and glycosylated hemoglobin levels. In this text, we tried to summarize known data about diagnosis, epidemiology, risk factors, pathophysiology, and prevention of prediabetes in relation to DM and stroke.

The effects of breakfast on short-term cognitive function among Chinese white-collar workers: protocol for a three-phase crossover study

BackgroundAs the first meal of the day, breakfast plays an important role in supplying energy and nutrients, which are critical to working and learning activities. A three-phase crossover study was designed to investigate the effects of breakfast on cognitive function among Chinese white-collar workers. The planned study protocol is presented.MethodsA total of 264 participants aged 25–45 years will be recruited from Shenyang and Chongqing. Self-administered questionnaires will be used to collect information on age, gender, marital status, education level, occupation, smoking habits, drinking habits, and breakfast behaviours. The participants will be randomly assigned to 3 equal-sized groups (Groups A, B, and C) and will be provided with a nutrition-adequate breakfast, a nutrition-inadequate breakfast, or no breakfast, respectively. Each participant will receive the breakfast treatment on the basis of assignment to one of three sequences (ABC/BCA/CAB). Each participant will complete a battery of cognitive tests assessing short-term memory, attention, and working memory 120 minutes after breakfast. Mood will be measured through a self-administered questionnaire assessing the dimensions of positive and negative frames of mind. Additionally, fasting blood glucose and postprandial 2-hour blood glucose levels will be tested with a blood-glucose meter (Roche ACCU-CHEK®-Performa). All the participants will take all the tests in three successive weeks, and the order of presentation will be counter-balanced across groups.DiscussionThe present study will be the first investigation of the effect of breakfast food type and quality on cognitive function amongst white-collar workers in China. We predict that a nutrition-adequate breakfast, compared with a nutrition-inadequate breakfast and no breakfast, will significantly improve short-term cognitive function. The results of this study should provide scientific evidence of the effect of breakfast quality on cognitive function and provide scientific data to inform nutrition education strategies and promote a healthy lifestyle.Trial registrationChinese clinical trial registry (Primary registry in the WHO registry network) Registration number: ChiCTR-IPR-15007114. Date of registration: August 25, 2015.

Can HbA1c be Used to Screen for Glucose Abnormalities Among Adults with Severe Mental Illness?

Aim: Prediabetes and type 2 diabetes are highly prevalent among individuals with serious mental illness and increased by antipsychotic medication. Although widely recommended, many obstacles prevent these patients from obtaining a proper screening for dysglycemia. Currently, glycated hemoglobin (HbA1c), fasting glucose, and 2-hour glucose levels from the oral glucose tolerance test are used for screening prediabetes and type 2 diabetes. The objective of this study was to investigate if HbA1c could be used as the only screening test among individuals with serious mental illness. Methods: Cross sectional study comparing the sensitivity of HbA1c, fasting glucose, and 2-h oral glucose tolerance test to detect dysglycemias in serious mental illness participants referred for metabolic complications. Results: A total of 84 participants (43 female; aged: 38.5±12.8 years; BMI: 35.0±6.8 kg/m²) was included. Regarding prediabetes, 44, 44 and 76% were identified by HbA1c, fasting glucose, and 2 h- oral glucose tolerance test respectively and for type 2 diabetes, 60, 53 and 66% were identified by HbA1c, fasting glucose and 2 h-oral glucose tolerance test. The overlap between the 3 markers was low (8% of participants for prediabetes and 26% for Type 2 diabetes). Sensitivity of HbA1c were moderate (range 40-62.5%), while its specificity was excellent (92-93%). Conclusion: The present study indicates a low agreement between HbA1c, fasting glucose and 2-h oral glucose tolerance test. It appears that these markers do not identify the same participants. Thus, HbA1c may not be used alone to detect all glucose abnormalities among individuals with serious mental illness.

Subtle inflammation: a possible mechanism of future cardiovascular risk in obese children.

PurposeThe risk of cardiovascular disease (CVD) has been shown to be associated with systemic inflammation in obese adults with metabolic syndrome (MetS). The aims of this study were to evaluate the prevalence of MetS and its relation to inflammatory markers in obese Thai children.MethodsA cross-sectional study was conducted. Children with history of endogenous obesity, chronic diseases, drug ingestion, and any acute illness within 2 weeks prior to enrollment were excluded. Their fasting blood glucose (FBG) levels, oral glucose tolerance tests, insulin, lipid profiles, and selected inflammatory markers, including interleukin-6, tumor necrosis factor-alpha, and high-sensitivity C-reactive protein (hs-CRP) levels, were tested.ResultsIn this study, 58 obese Thai children (female, 20; male, 38) with a mean body mass index z score of 5.1±2.2 were enrolled. The prevalence of MetS and prediabetes was 31% and 17.2%, respectively. None of the children had diabetes. FBG levels, 2-hour glucose levels, and lipid profiles were not statistically different between those with and without MetS. However, obese children with MetS had higher insulin levels and homeostasis model assessment of insulin resistance values. Elevated hs-CRP levels were found in 69% of the cases, although it was not statistically different between the 2 groups.ConclusionWe described a substantial prevalence of MetS in Thai obese children. Regardless of MetS status, two-thirds of the obese children had elevated hs-CRP level, indicating subtle ongoing inflammatory process. This chronic inflammation feasibly predisposes them to CVD in the future, even in children without MetS.

Associated Factors with Biochemical Hypoglycemia during an Oral Glucose Tolerance Test in a Chinese Population.

Aim To find the association between biochemical hypoglycemia on a 2-hour screening oral glucose tolerance test (OGTT) and insulin resistance. Method Subjects of this study were sampled from the China National Diabetes and Metabolic Disorders Study that was conducted during 2007 and 2008. Blood samples were drawn at 0, 30, and 120 minutes after the glucose load. Biochemical hypoglycemia was defined as 2-hour glucose < 3.0 mmol/l. Results In total, 26,606 participants were included, and 141 participants were diagnosed with biochemical hypoglycemia on a 2-hour OGTT. Compared to participants with normal glucose tolerance (NGT), participants with biochemical hypoglycemia presented with a younger age, lower BMI, lower levels of fasting glucose, and lower levels of 30-minute and 2-hour OGTT glucose. In terms of insulin resistance, participants with biochemical hypoglycemia showed higher levels of Matsuda ISI. In terms of β-cell function, participants with biochemical hypoglycemia showed higher levels of Stumvoll early and late indexes. A multivariate regression analysis indicated that higher levels of Matsuda ISI and higher levels of Stumvoll early and late indexes were associated with biochemical hypoglycemia independently. Conclusion This study indicated that biochemical hypoglycemia might be associated with lower levels of insulin resistance but higher levels of β-cell function in a Chinese population.

Influencing Factors of Knowledge, Attitude, and Practice regarding Medical Nutrition Therapy in Patients with Diabetes: A National Cross-Sectional Study in Urban China.

To investigate the knowledge-attitude-practice (KAP) score in diabetes patients living in urban China regarding Medical Nutrition Therapy (MNT) and explore the influencing factors, this national survey recruited diabetes and prediabetes patients in 40 hospitals across 26 provinces in China. A self-designed questionnaire was used to collect the data and assess the knowledge, attitude, and practice regarding MNT. Logistic regression was used to explore the factor influencing KAP scores. A total of 6441 diabetes patients (mean age: 60.02 ± 13.14 years) completed this survey. The mean glycosylated hemoglobin (HbA1c) level was 8.12 ± 2.12%, and the control rate of HbA1c (HbA1c < 7.0%) was 38.92%. Of the total, 53.56% had received MNT education. Over half of the patients had a poor total KAP score as well as poor K, A, and P scores. Patients with higher KAP scores had higher control rate of HbA1c (P < 0.05) but lower levels of fasting plasma glucose (FPG) and 2-hour postprandial blood glucose (2h-PG). Gender, occupation, residence, education level, and MNT education could influence the KAP scores (P < 0.05). This study showed that diabetes patients in urban China generally had poor understandings and practices related to MNT. Patients with higher KAP scores exhibited better control of blood glucose.

Screening for Gestational Diabetes Among Pregnant Women Attending a Rural Family Health Center- Menoufia Governorate- Egypt

<i>Objectives:</i> Study prevalence of gestational diabetes mellitus (GDM) among pregnant females attending family health center between 24 and 28 weeks of gestation and assessment of risk factors among the studied group. <i>Background:</i> Gestational diabetes mellitus (GDM) is the most prevalent metabolic disorder during pregnancy. It is defined as any degree of glucose intolerance during pregnancy. It affects between 2-14% of pregnancies. Screening for (GDM) during pregnancy is highly recommended. <i>Material and Methods:</i> The study was conducted on 250 pregnant women between 24 and 28 weeks gestation who attended a rural family health center in Menufia Governorate, Egypt. Selected participants were interviewed during their antenatal care visits using a questionnaire to assess different demographic criteria of the participants and potential risk factors for GDM. Initial screening was done by a glucose challenge test with 50 g glucose. If the 1-hour blood glucose level exceeded 130 mg/dl, then a 3-hour oral glucose tolerance test (OGTT) with 100g glucose was performed and diagnosis was established. <i>Results:</i> Prevalence of GDM among the studied group was 8%. Risk factors found to be significantly associated with GDM were advancing age & BMI ≥ 30, high BP> 140/90, previous history of pre-eclampsia, family history of diabetes and positive obstetric history for induced labor, abortion and large size baby. However socioeconomic status, previous history of hypertension and family history of hypertension failed to demonstrate significant associations with GDM. <i>Conclusion:</i> The prevalence of GDM was found to be 8% among pregnant females attending the studied rural family health center. Controlling risk factors and Screening for early detection are mandatory for better maternal and fetal health.

Short Adult Stature Predicts Impaired β-Cell Function, Insulin Resistance, Glycemia, and Type 2 Diabetes in Finnish Men.

Recent studies have highlighted the role of height in complex diseases, but conflicting information has been reported on height as a predictor of changes in glycemia and risk of type 2 diabetes. Our aim was to investigate the association of height with insulin sensitivity, insulin secretion, glycemia, type 2 diabetes, and cardiovascular disease (CVD) in a large prospective population-based study. The study included 8746 Finnish men (mean ± standard deviation, age 57.2 ± 7.1 years, body mass index, 26.8 ± 3.8 kg/m2) selected from a population-based Metabolic Syndrome in Men (METSIM) study. The study was conducted at Kuopio University Hospital and University of Eastern Finland. The participants were nondiabetic at the recruitment, and 5401 subjects have participated in the follow-up study. During the follow-up, a total of 693 subjects converted to type 2 diabetes and 351 were diagnosed with a new CVD event during the follow-up. The main outcome measures were incidence of type 2 diabetes and CVD. Height measured at baseline was significantly associated with lower levels of 2-hour glucose in an oral glucose tolerance test, an increase in insulin secretion, a decrease in the risk of type 2 diabetes [hazard ratio (HR) = 0.83(confidence interval [CI] 0.77 to 0.90)] and CVD [HR = 0.75(CI 0.67 to 0.83)] during the follow-up. Short stature is associated with unfavorable changes in glucose metabolism and predicts an increase in the risk of type 2 diabetes and cardiovascular events.

Spontaneous and transient predinner hyperglycemia in some patients with diabetes: Dusk phenomenon.

Blood glucose fluctuations have higher risk than absolute blood glucose level in diabetic chronic complications. At present, “dawn phenomenon” is well known by clinicians, but “dusk phenomenon” has not been recognized. This study explored the objective existence of “dusk phenomenon” (spontaneous and transient predinner hyperglycemia) and its clinical significance.The data of 54 patients with diabetes, who received routine insulin pump therapy between December 2010 and October 2012 in our hospital, were retrospectively analyzed. These patients included 4 patients with type 1 diabetes mellitus (DM) (T1DM) and 50 patients with type 2 DM (T2DM). According to the difference between predinner and postlunch blood glucose levels, the 50 patients with T2DM were divided into dusk phenomenon group (4 patients, all the differences ≥0 mmol/L during insulin pump therapy), nondusk phenomenon group (12 patients, all the differences <0 mmol/L during insulin pump therapy), and suspicious group (34 patients, the differences were uncertain during insulin pump therapy). In the 4 patients with T1DM of this study, the differences all were more than 0 mmol/L during insulin pump therapy. The changes in blood glucose levels were observed, and the correlations of blood glucose level with other factors were analyzed in T1DM and T2DM patients, respectively.In T1DM patients, blood glucose level was significantly higher in predinner than in prebreakfast and prelunch (all P < 0.01), and in postdinner 2 hour than in postlunch 2 hour (P = 0.021). The predinner blood level had no significant correlations with the blood glucose level at other time points and insulin dosages (all P > 0.05). In T2DM patients, the predinner blood glucose level was significantly higher in dusk phenomenon group than in suspicious group and nondusk phenomenon group (all P < 0.05). In dusk phenomenon group, the blood glucose level remained rising from predinner to prebed, and the predinner blood glucose level was only significantly correlated with postdinner 2-hour blood glucose level (P < 0.05).The “dusk phenomenon” (spontaneous and transient predinner hyperglycemia) is an objective existence in some patients with diabetes. The predinner hyperglycemia can affect blood glucose control between postdinner and prebed. Awareness of the “dusk phenomenon” has important clinical significance.

SEDding Ourselves Up for Problems

SEDding Ourselves Up for Problems

A Prospective Study of Renal Transplant Recipients: A Fall in Insulin Secretion Underpins Dysglycemia After Renal Transplantation.

BackgroundDysglycemia (encompassing impaired glucose tolerance and diabetes mellitus) arising after renal transplantation is common and confers a significant cardiovascular mortality risk. Nonetheless, the pathophysiology of posttransplant dysglycemia is not well described. The aim of this study was to prospectively and comprehensively assess glucose handling in renal transplant recipients from before to 12 months after transplantation to determine the underpinning pathophysiology.Materials and MethodsIntravenous and oral glucose tolerance testing was conducted before and at 3 and 12 months posttransplantation. An intravenous glucose tolerance test was also performed on day 7 posttransplantation. We followed up 16 transplant recipients for 3 months and 14 recipients for 12 months. Insulin secretion, resistance and a disposition index (DI (IV)), a measure of β cell responsiveness in the context of prevailing insulin resistance, were also determined.ResultsAt 12 months, 50% of renal transplant recipients had dysglycemia. Dysglycemia was associated with a dramatic fall in DI (IV) and this loss in β cell function was evident as early as 3 months posttransplantation (23.5 pretransplant; 6.4 at 3 months and 12.2 at 12 months posttransplant). Differences in the β cell response to oral glucose challenge were evident pretransplant in those destined to develop dysglycemia posttransplant (2-hour blood glucose level 5.6 mmol/L versus 6.8 mmol/L; P < 0.01).ConclusionsDysglycemia after renal transplantation is common, and the loss of insulin secretion is a major contributor. Subclinical differences in glucose handling are evident pretransplant in those destined to develop dysglycemia potentially heralding a susceptible β cell which under the stressors associated with transplantation fails.

Telemedicine in the Management of Type 2 Diabetes Mellitus

ObjectiveTo explore a model of Internet-based integrated management of diabetes, we established a remote diabetes medical service platform (U-Healthcare) and evaluated its effectiveness and practicality. Materials and MethodsIn total, 212 patients with type 2 diabetes mellitus were randomly assigned to 2 groups. Data from the intervention group were automatically transmitted through a glucometer; furthermore, this group received information regarding medicines, diet, exercise and other management through U-Healthcare. The control group received conventional medical treatment without any additional intervention. All patients were regularly followed up every 3 months for half a year. ResultsAt the 3-month follow-up, fasting plasma glucose levels of the intervention group were significantly lower than those at the baseline as well as those of the control group. Triglyceride levels of the intervention group were much lower than those at the baseline. At the 6-month follow-up, 2-hour postprandial plasma glucose levels of the intervention group significantly improved compared with those of the control group. HbA1c levels gradually decreased every 3 months in the intervention group, and the mean change in the levels was significantly greater in this group than in the control group (from 1.27-0.68%). At the end of the study, more than 80% of the patients in the intervention group adhered to blood glucose monitoring 2-3 days per week, and their compliance degree was 72%. ConclusionsThe Internet-based U-Healthcare system of integrated management in diabetes not only achieved better glycemic control, effectively improved HbA1c levels and decreased triglyceride levels but also enhanced patients’ adherence to the medical team’s instructions.

The Influence of Gestational Diabetes on Neurodevelopment of Children in the First Two Years of Life: A Prospective Study.

ObjectiveAnalyze the relation of gestational diabetes and maternal blood glucose levels to early cognitive functions in the first two years of life.MethodsIn a prospective Singaporean birth cohort study, pregnant women were screened for gestational diabetes at 26–28 weeks gestation using a 75-g oral glucose tolerance test. Four hundred and seventy three children (n = 74 and n = 399 born to mothers with and without gestational diabetes respectively) underwent neurocognitive assessments at 6, 18, and/or 24 month, including electrophysiology during an attentional task and behavioral measures of attention, memory and cognition.ResultsGestational diabetes is related to left hemisphere EPmax amplitude differences (oddball versus standard) at both six (P = 0.039) and eighteen months (P = 0.039), with mean amplitudes suggesting offspring of mothers with gestational diabetes exhibit greater neuronal activity to standard stimuli and less to oddball stimuli. Associations between 2-hour maternal glucose levels and the difference in EPmax amplitude were marginal at 6 months [adjusted β = -0.19 (95% CI: -0.42 to +0.04) μV, P = 0.100] and significant at 18 months [adjusted β = -0.27 (95% CI: -0.49 to -0.06) μV, P = 0.014], and the EPmax amplitude difference (oddball-standard) associated with the Bayley Scales of Infant and toddler Development-III cognitive score at 24 months [β = 0.598 (95% CI: 0.158 to 1.038), P = 0.008].ConclusionGestational diabetes and maternal blood glucose levels are associated with offspring neuronal activity during an attentional task at both six and eighteen months. Such electrophysiological differences are likely functionally important, having been previously linked to attention problems later in life.

Postpartum Reclassification of Glycemic Status in Women with Gestational Diabetes Mellitus and Associated Risk Factors.

Objective The aims of the study were to evaluate, after pregnancy, the glycemic status of women with history of gestational diabetes mellitus (GDM) and to identify clinical variables associated with the development of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT). Methods Retrospective cohort of 279 women with GDM who were reevaluated with an oral glucose tolerance test (OGTT) after pregnancy. Characteristics of the index pregnancy were analyzed as risk factors for the future development of prediabetes (IFG or IGT), and T2DM. T2DM was diagnosed in 34 (12.2%) patients, IFG in 58 (20.8%), and IGT in 35 (12.5%). Women with postpartum T2DM showed more frequently a family history of T2DM, higher pre-pregnancy body mass index (BMI), lower gestational age, higher fasting and 2-hour plasma glucose levels on the OGTT at the diagnosis of GDM, higher levels of hemoglobin A1c, and a more frequent insulin requirement during pregnancy. Paternal history of T2DM (odds ratio [OR] = 5.67; 95% confidence interval [95%CI] = 1.64-19.59; p = 0.006), first trimester fasting glucose value (OR = 1.07; 95%CI = 1.03-1.11; p = 0.001), and insulin treatment during pregnancy (OR = 15.92; 95%CI = 5.54-45.71; p < 0.001) were significant independent risk factors for the development of T2DM. Conclusion A high rate of abnormal glucose tolerance was found in women with previous GDM. Family history of T2DM, higher pre-pregnancy BMI, early onset of GDM, higher glucose levels, and insulin requirement during pregnancy were important risk factors for the early identification of women at high risk of developing T2DM. These findings may be useful for developing preventive strategies.

A Randomized Clinical Trial of an Intensive Behavior Education Program in Gestational Diabetes Mellitus Women Designed to Improve Glucose Levels on the 2-Hour Oral Glucose Tolerance Test.

Objective To evaluate whether women with gestational diabetes mellitus (GDM) enrolled in an intensive behavior education program (IBEP) demonstrate lower mean fasting glucose levels on the 2-hour 75 g oral glucose tolerance test (2-hour OGTT) at 6 to 12 weeks postpartum compared with women who undergo routine GDM management. Study Design A prospective randomized controlled trial of women diagnosed with GDM was conducted. Exclusion criteria were GDM diagnosis ≥ 33 weeks or < 20 weeks. Women were randomly assigned to one of two treatment arms: (1) routine GDM management or (2) an IBEP. Women underwent a 2-hour OGTT at 6 to 12 weeks postpartum. Fisher exact test, t-test, and Wilcoxon rank sum test were used as appropriate. Results Of the 101 women randomized, 49 were assigned to IBEP and 52 received routine GDM management. There was no difference in mean fasting and 2-hour glucose levels on the postpartum 2-hour OGTT between the IBEP and routine management group (88.5 ± 22.9 mg/dL vs. 85.2 ± 13.3 mg/dL, p = 0.49 and 109.8 ± 38.5 mg/dL vs. 109.4 ± 40.8 mg/dL, p = 0.97, respectively). Conclusion GDM women enrolled in a healthy lifestyle intervention program did not demonstrate lower glucose values on the postpartum 2-hour OGTT.

Chicken or Egg Causality Paradox Between Insulin Resistance and Epicardial Fat.

Altin et al 1 reported that carotid intima–media thickness (cIMT) and epicardial fat thickness (EFT) are significantly increased among patients with prediabetes, particularly in those with impaired glucose tolerance (IGT), compared to the control group. Age, waist circumference, and 2-hour glucose level independently predicted cIMT, but only 2-hour glucose was an independent predictor of EFT. Insulin resistance (IR) and central obesity are key elements of the metabolic syndrome (MetS). Central obesity also causes IR, hypertension, and dyslipidemia via secretion of various cytokines from adipocytes. 2,3 Nonalcoholic fatty liver disease (NAFLD), known as the hepatic manifestation of MetS, is also significantly associated with increased cardiovascular risk. 4 In turn, MetS is associated with an increased risk of subclinical and clinical atherosclerotic diseases. 5 Epicardial adipose tissue secretes several proinflammatory molecules and plays a role similar to an endocrine or paracrine organ. 6 Epicardial fat thickness has been significantly associated with various cardiovascular risk factors and disease conditions. 7-10 Yorgun et al 7 showed that EFT measured by computerized tomography might be an indicator for the presence of MetS. They also reported a graded relationship between increasing number of MetS components and EFT. In another study, in patients with NAFLD, waist circumference, and cIMT independently predicted EFT. 11 In addition, epicardial fat was significantly associated with gamma-glutamyltransferase (GGT) activity 12 as an indicator of both MetS and NAFLD. 13 In the study by Altin et al, 1 serum GGT levels were significantly higher in patients with prediabetes, which might be due to a higher rate of NAFLD in those patients. Such a link between increased EFT and MetS might be due to IR. However, the exact pathogenesis whether increased EFT promotes IR and MetS or vice versa was unclear. 14-16 Thus, Altin et al 1 should comment on this issue. They may consider the impact of MetS components as a whole rather than including each component alone like IGT, waist circumference, and so on. We speculate that increased cIMT and EFT in the patient group of this study might be due to higher IR as measured by homeostasis model assessment index of IR and MetS components as a whole rather than impaired glucose metabolism alone.

Epidemiology of Diabetes and Risk of Dementia

The association between diabetes and the risk of developing dementia has received much attention in epidemiological studies. An accurate population-based prospective cohort study has been conducted in the elderly population of the town of Hisayama in Japan since 1985 aiming to elucidate the secular trends in the prevalence of dementia and examine risk and protective factors for dementia in the Japanese population. The prevalence of all-cause dementia significantly increased from 1985 to 2012. In regard to subtypes of dementia, a similar trend was observed for Alzheimer's disease (AD). In a prospective study of risk factors for dementia in Hisayama elder residents without dementia, diabetes was identified as a significant risk factor for developing all-cause dementia, especially AD. Moreover, 2-hour post-load glucose levels were closely associated with increased risk of all-cause dementia, AD, and vascular dementia. In a pathological study of Hisayama residents, higher levels of 2-hour post-load glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) were significantly associated with increased risk of neuritic plaques. The steep increase in the frequency of diabetes could lead to the increasing trend in the prevalence of dementia, especially AD, in the Japanese elderly.

Physical Activity Is Associated With Glucose Tolerance Independent of Microvascular Function: The Maastricht Study

Moderate-to-vigorous physical activity (MVPA) and physical fitness (PF) are positively associated with glucose tolerance. Such associations may be partly conditioned by microvascular function, which is a common correlate to MVPA, PF, and glucose tolerance. To test this hypothesis, the present study sought to investigate independent associations of MVPA and PF with glucose tolerance and to what extent these associations are mediated by microvascular function. Design, Setting, Participants, and Outcome Measures: Data from The Maastricht Study were used (n = 512 for MVPA and n = 488 for PF analyses; mean age, 59 [SD = 9] y, 52 % men). Glucose tolerance was assessed by 2-hour postload plasma glucose levels (2hPG). The total number of weekly hours of MVPA was estimated with the Community Healthy Activities Model Program for Seniors questionnaire. Walking speed during the 6-minute walk test was used to evaluate PF. Microvascular function was determined by postocclusive capillary recruitment and flowmotion with capillaroscopy and laser Doppler flowmetry in skin microcirculation. In univariate analyses, MVPA, PF, and microvascular function variables were associated with 2hPG. MVPA (n = 512, β = -0.056, P = .019) and PF (n = 488, β = -0.368, P = .006) remained associated with 2hPG after adjustment for established cardio-metabolic risk factors and history of cardiovascular disease; addition of microvascular function variables as potential mediators did not materially change the associations of MVPA (β = -0.054, P = .024) and PF (β = -0.364, P = .006) with 2hPG. No mediation effects of microvascular function variables were detected. MVPA and PF were independently associated with 2hPG, irrespective of established risk factors and generalized microvascular function. The possibility that specific microvascular functions, eg, insulin-mediated vasodilation, influence the association of MVPA and PF with 2hPG needs further investigation.

Validation of Chinese Version of Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (Chi-PCOSQ).

ObjectivesTo evaluate the responsiveness, longitudinal validity, and measurement invariance of the Chinese version of the Polycystic Ovary Syndrome Health-related Quality of Life Questionnaire (Chi-PCOSQ).Research Design and MethodThis prospective study was conducted in a medical center in southern Taiwan. 102 women aged 18–45 years and diagnosed with PCOS were enrolled. Objective indicators for clinical changes of PCOS included assessing the 2-hour glucose and insulin levels before and after treatment. The responsiveness of Chi-PCOSQ and WHOQOL-BREF was analyzed using paired t-tests and the standard response mean. Confirmatory factor analysis was performed to assess the measurement invariance of Chi-PCOSQ.ResultsWith improved 2-hour glucose and insulin levels, we also found significantly increased Chi-PCOSQ total and individual domain scores (total score: t (49) = 5.20; p < 0.001, domain scores: t (49) = 2.72 to 3.87; p < 0.01), except for hair growth. Half of the domains scores (3 of 6) and the total score of Chi-PCOSQ had a medium responsiveness, but WHOQOL-BREF was not sufficiently responsive to clinical changes of PCOS. Improved PCOS-specific health-related quality of life (HRQoL), as indicated by Chi-PCOSQ scores, was significantly associated with improved 2-hour glucose and insulin levels. All indices of the data-model fit of the Chi-PCOSQ structure were satisfactory, except for the slightly high standardized root mean square residual values (0.087 to 0.088). The measurement invariance of Chi-PCOSQ was supported across time.ConclusionChi-PCOSQ is sufficiently sensitive in detecting clinical changes and its measurement structure is suitable for Chinese women with PCOS. It is thus a promising tool for assessing the HRQoL of ethnic Chinese women with PCOS.

Effect of metformin by employing 2-hour postload insulin for measuring insulin resistance in Taiwanese women with polycystic ovary syndrome.

Evidence on clinical effectiveness of metformin in ethnic Chinese women with polycystic ovary syndrome (PCOS) remains scarce. Standard diagnostic approaches to identify insulin resistance (IR) cases in PCOS patients might be invasive, labor intensive, and stressful for patients (i.e., euglycemic clamp), or somewhat complicated for clinicians to calculate and monitor in routine practice [i.e., the homeostatic model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI)]. The aim of this study was to evaluate the clinical effects of metformin in Taiwanese women with PCOS and identify the feasible diagnostic measures of IR for Taiwanese women with PCOS. A total of 114 women from a medical center in Taiwan were studied. All were aged between 18years and 45years, diagnosed with PCOS according to the Rotterdam criteria, and treated with metformin. Outcome end points were body mass index (BMI) and 2-hour postload glucose and insulin levels from a 75-g oral glucose tolerance test. BMI in overweight patients were significantly improved with metformin treatment duration (p<0.001). The 2-hour insulin level statistically improved after treatment (before: 80.7±63.9μIU/mL vs. after: 65.0±60.4μIU/mL; p=0.009). The improved 2-hour insulin level was significantly greater in IR patients than in non-IR patients. Compared with the 2-hour postload insulin level, the fasting insulin level provided 18.15% sensitivity and 94.12% specificity, the HOMA yielded 40% sensitivity and 70.58% specificity, and the QUICKI achieved 63.63% sensitivity and 11.76% specificity. Clinical outcomes in Taiwanese PCOS women were improved with metformin treatment, especially in overweight and IR patients. The 2-hour postload insulin level appears to be a convenient tool for screening IR in Taiwanese patients.