2-hour Glucose Levels Research Articles

Fasting blood glucose and newborn birth weight of non- diabetic Sudanese women

Background Although risk factors for abnormal birth weight has been extensively investigated, whether the physiological range of glucose tolerance affects birth weight in non-diabetic mothers needs to be verified by further research. Objectives To assess the effect of maternal sociodemographic characteristics, obstetric and anthropometric measurements, fasting and 2-hour blood glucose levels on birth weight. Methods One hundred and thirty four women were followed from early pregnancy until delivery at Saad Abualila Hospital, Khartoum, Sudan. Fasting and 2-hour glucose levels following administration of 75 g oral glucose was performed in the third trimester. Association between birth weight and maternal sociodemographic characteristics, obstetric and anthropometric measurements, haemoglobin, fasting and 2-hour blood glucose levels were assessed by linear regression analysis. Results The mean (SD) birth weight was 3127.7 (480.0) g, while the 10th and 90th centile were 2500 and 3800 g, respectively. There was no significant difference in the birth weight between male (n=73) and female (n=61) newborns [3167.8 (545.0) vs 3068.9 (384.0) g, P= 0.196]. Likewise there was no significant difference in the birth weight of newborns born to primipara and multipara mothers [3101.7 (529.0) g vs 3151.4 (432.0) g, P= 0.551]. Linear regression analysis demonstrated significant association between fasting blood glucose and birth weight (20 g, P = 0.028). None of the other maternal/fetal characteristics was associated with birth weight, including maternal age, body mass index, gravidity, weight gain during pregnancy, interpregnancy interval, history of miscarriage, haemoglobin level, blood pressure, fetal gender and gestational age. Conclusion In this study fasting blood glucose was found to be predictor of birth weight among neonates of non-diabetic Sudanese mothers.

Insulin sensitizer in prediabetes: a clinical study with DLBS3233, a combined bioactive fraction of Cinnamomum burmanii and Lagerstroemia speciosa.

BackgroundThe aim of this paper is to evaluate the efficacy and safety of DLBS3233, a novel bioactive fraction derived from Cinnamomum burmanii and Lagerstroemia speciosa, in improving insulin resistance and preserving β-cell performance in patients with impaired glucose tolerance (IGT).Patients and methodsEighty adult subjects with IGT, defined as 2-hour postprandial glucose level of 140–199 mg/dL, were enrolled in this two-arm, 12-week, double-blind, randomized, placebo-controlled preliminary study. Eligible subjects were randomly allocated to receive either DLBS3233 at a dose of 50–100 mg daily or placebo for 12 weeks. The study mainly assessed the improvement of homeostatic model-assessed insulin resistance (HOMA-IR), the 15-minute and 2-hour plasma insulin levels, and the oral disposition index.ResultsAfter 12 weeks, DLBS3233 improved insulin resistance better than placebo as reflected by a reduced HOMA-IR (−27.04%±29.41% vs −4.90%±41.27%, P=0.013). The improvement of the first- and second-phase insulin secretion was consistently greater in DLBS3233 group than placebo group (−144.78±194.06 vs −71.21±157.19, P=0.022, and −455.03±487.56 vs −269.49±467.77, P=0.033, respectively). Further, DLBS3233 also significantly better improved oral disposition index than placebo. No serious hypoglycemia, edema, or cardiovascular-related adverse events were found in either groups.ConclusionThis study has shown that DLBS3233 at the dose of 50–100 mg once daily was well tolerated, and promisingly efficacious in improving insulin sensitivity as well as preserving β-cell performance in subjects with IGT.

A Pilot Study Evaluating Steroid-Induced Diabetes after Antiemetic Dexamethasone Therapy in Chemotherapy-Treated Cancer Patients.

PurposeDexamethasone is a mainstay antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting. The aim of this pilot study was to assess the incidence of and factors associated with steroid-induced diabetes in cancer patients receiving chemotherapy with dexamethasone as an antiemetic.Materials and MethodsNon-diabetic patients with newly diagnosed gastrointestinal cancer who received at least three cycles of highly or moderately emetogenic chemotherapy with dexamethasone as an antiemetic were enrolled. Fasting plasma glucose levels, 2-hour postprandial glucose levels, and hemoglobin A1C tests for the diagnosis of diabetes were performed before chemotherapy and at 3 and 6 months after the start of chemotherapy. The homeostasis model assessment of insulin resistance (HOMA-IR) was used as an index for measurement of insulin resistance, defined as a HOMA-IR ≥ 2.5.ResultsBetween January 2012 and November 2013, 101 patients with no history of diabetes underwent laboratory tests for assessment of eligibility; 77 of these patients were included in the analysis. Forty-five patients (58.4%) were insulin resistant and 17 (22.1%) developed steroid-induced diabetes at 3 or 6 months after the first chemotherapy, which included dexamethasone as an antiemetic. Multivariate analysis showed significant association of the incidence of steroid-induced diabetes with the cumulative dose of dexamethasone (p=0.049).ConclusionWe suggest that development of steroid-induced diabetes after antiemetic dexamethasone therapy occurs in approximately 20% of non-diabetic cancer patients; this is particularly significant for patients receiving high doses of dexamethasone.

Association between the rs7903146 Polymorphism in the TCF7L2 Gene and Parameters Derived with Continuous Glucose Monitoring in Individuals without Diabetes.

BackgroundThe rs7903146-T allele in the transcription factor 7-like 2 (TCF7L2) gene has been associated with impaired pancreatic insulin secretion, enhanced liver glucose production, and an increased risk of type 2 diabetes. Nevertheless, the impact of rs7903146 on daily glucose trajectories remains unclear. Continuous glucose monitoring (CGM) can estimate glycemia and glycemic variability based on consecutive glucose measurements collected over several days. The purpose of the present study was to investigate the associations of rs7903146 with glycemia and glycemic variability in middle-aged participants without diabetes.MethodsComplete data from 235 participants without diabetes from the Leiden Longevity Study were available. Participants were divided into two groups based on rs7903146 genotype; rs7903146-CC genotype carriers (N = 123) and rs7903146-CT/TT genotype carriers (N = 112). Validated parameters of glycemia (e.g., mean 24h glucose level) and glycemic variability (e.g., 24h standard deviation) were derived from data collected with a CGM system for a 72-hour period.ResultsThe study population was on average 64.7 years old (standard deviation = 5.9) and composed of 49.8% of women. Compared with rs7903146-CC carriers, rs7903146-CT/TT carriers exhibited a trend towards a higher mean 24-hour glucose level (5.21 versus 5.32 mmol/L; p-value = 0.15) and a significantly higher mean nocturnal glucose (3:00am– 6:00am; 4.48 versus 4.67 mmol/L; p-value = 0.03) that was explained for 34.6% by body weight and percentage body fat. No differences in measures of glycemic variability between the genotype groups were observed.ConclusionDespite limited sample size, our study indicates that the rs7903146-T allele in TCF7L2 was associated with a higher mean nocturnal glucose dependent on body composition, which might suggest that rs7902146 affects liver-specific aspects of glucose metabolism.

Maternal 75-g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus.

Our goal was to investigate which glucose measurement from the 75-g oral glucose tolerance test (OGTT) has more capability of predicting large for-gestational-age (LGA) newborns of mothers with gestational diabetes mellitus (GDM). The study group consisted of 118 consecutively pregnant women with singleton pregnancy, patients of Outpatients Department of the Endocrinology, Diabetes, and Metabolic Disorders Clinic. All were prospectively screened for GDM between 24th and 28th week of pregnancy and followed to delivery. Outcome measures included: patients' ages, pre-pregnancy BMI, BMI before delivery, FPG, 1 and 2 hour OGTT glucose values, haemoglobin A1c at third trimester, gestational week of delivery, mode of delivery and baby birth weight. From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. There were statistically significant differences (30.7 versus 5.0%, p < 0.01) between LGA newborns from GDM and control group, respectively. Gestation week of delivery and fasting glucose levels were independent predictors for LGA (Beta = 0.58 and Beta = 0.37 respectively, p < 0.01). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA (0.782 (0.685-0.861) for fasting, 0.719 (0.607-0.815) for 1-hour and 0.51 (0.392-0.626) for 2-hour OGTT plasma glucose levels). Fasting and 1-hour plasma glucose levels from OGTT may predict LGA babies in GDM pregnancies.

Randomized, Double-Blinded, Double-Dummy, Active-Controlled, and Multiple-Dose Clinical Study Comparing the Efficacy and Safety of Mulberry Twig (Ramulus Mori, Sangzhi) Alkaloid Tablet and Acarbose in Individuals with Type 2 Diabetes Mellitus.

Aims. To evaluate the efficacy and safety of mulberry twig alkaloid (SZ-A) tablet compared with acarbose in patients with type 2 diabetes. Methods. This clinical trial enrolled 38 patients who were randomized into two groups (SZ-A: 23; acarbose: 15) and were treated for 24 weeks. Patients and clinical trial staffs were masked to treatment assignment throughout the study. The primary outcome measures were glycated hemoglobin (HbA1c) and 1-hour and 2-hour postprandial and fasting plasma glucose levels from baseline to the end of treatment. Analysis included all patients who completed this study. Results. By the end of this study, HbA1c level in SZ-A group was decreased from baseline significantly (P < 0.001). No significant difference was found when compared with acarbose group (P = 0.652). Similarly, 1-hour and 2-hour postprandial plasma glucose levels in SZ-A group were decreased from baseline statistically (P < 0.05), without any significant differences compared with acarbose group (P = 0.748 and 0.558, resp.). The fasting plasma glucose levels were not significantly changed in both groups. One of 23 patients in SZ-A group (4.76%) and 5 of 15 patients in acarbose group (33.33%) suffered from gastrointestinal adverse events. Conclusions. Compared with acarbose, SZ-A tablet was effective and safe in glycemic control in patients with type 2 diabetes.

Comparison between the Oral Glucose Tolerance Test and the Hba1c Assay for Detecting Impaired Glucose Regulation in Bahamian Adolescents

Objective: To determine the best method for detecting Impaired Glucose Regulation (IGR) in adolescents from New Providence Island, Bahamas. IGR is defined by blood glucose levels that are higher than normal but below those of a person with diabetes. Design and Methods: From Jan-March 2012, 873 adolescents (13-19 years old) were randomly selected from five different high schools in New Providence. Weight and height were measured and participants were screened for IGR using the hemoglobin A1c (HbA1c) test and a 2-hour oral glucose tolerance test (OGTT). T-test or chi-square test was used to determine significant associations between sex and outcome variables, and prevalence of glycemic status by BMI category. Linear regression was used to determine the relationship between OGTT results and BMI. Results: Of the initial pool, 861 adolescents (98.6%) completed the study. The OGTT demonstrated that 89.4% of these students had normal fasting glucose levels and 98.8% had normal 2-hour OGTT glucose levels. Eightyseven students (37 boys and 50 girls) had elevated fasting plasma glucose; however, 2 hours after the oral glucose load, only 9 students (2 boys and 7 girls) had blood glucose concentrations indicative of IGR. For the HbA1c test, 82.6% of the students had normal results, and 1.3% had diabetes. The HbA1c test revealed a higher percentage of students with IGR (16.1%) than the OGTT (1%). Conclusions: The HbA1c test identified a greater percentage of adolescents as having IGR than did the OGTT. Due to the high discordance between the two tests, it is likely that an elevated HbA1c test may falsely classify adolescents as IGR if OGTT results and clinical signs (e.g., diabetic retinopathy and/or nephropathy) are not considered.

Can Fasting Glucose Levels or Post-Breakfast Glucose Fluctuations Predict the Occurrence of Nocturnal Asymptomatic Hypoglycemia in Type 1 Diabetic Patients Receiving Basal-Bolus Insulin Therapy with Long-Acting Insulin?

ObjectiveTo investigate whether the occurrence of nocturnal asymptomatic hypoglycemia may be predicted based on fasting glucose levels and post-breakfast glucose fluctuations.Patients and MethodsThe study subjects comprised type 1 diabetic patients who underwent CGM assessments and received basal-bolus insulin therapy with long-acting insulin. The subjects were evaluated for I) fasting glucose levels and II) the range of post-breakfast glucose elevation (from fasting glucose levels to postprandial 1- and 2-hour glucose levels). The patients were divided into those with asymptomatic hypoglycemia during nighttime and those without for comparison. Optimal cut-off values were also determined for relevant parameters that could predict nighttime hypoglycemia by using ROC analysis.Results64 patients (mean HbA1c 8.7 ± 1.8%) were available for analysis. Nocturnal asymptomatic hypoglycemia occurred in 23 patients (35.9%). Fasting glucose levels (I) were significantly lower in those with hypoglycemia than those without (118 ± 35 mg/dL vs. 179 ± 65 mg/dL; P < 0.001). The range of post-breakfast glucose elevation (II) was significantly greater in those with hypoglycemia than in those without (postprandial 1-h, P = 0.003; postprandial 2-h, P = 0.005). The cut-off values determined for relevant factors were as follows: (I) fasting glucose level < 135 mg/dL (sensitivity 0.73/specificity 0.83/AUC 0.79, P < 0.001); and (II) 1-h postprandial elevation > 54 mg/dL (0.65/0.61/0.71, P = 0.006), 2-h postprandial elevation > 78 mg/dL (0.65/0.73/0.71, P = 0.005).ConclusionsNocturnal asymptomatic hypoglycemia was associated with increases in post-breakfast glucose levels in type 1 diabetes. Study findings also suggest that fasting glucose levels and the range of post-breakfast glucose elevation could help predict the occurrence of nocturnal asymptomatic hypoglycemia.

Association between Glucose Metabolism and Sleep-disordered Breathing during REM Sleep

Sleep-disordered breathing (SDB) has been associated with impaired glucose metabolism. It is possible that the association between SDB and glucose metabolism is distinct for non-REM versus REM sleep because of differences in sleep-state-dependent sympathetic activation and/or degree of hypoxemia. To characterize the association between REM-related SDB, glucose intolerance, and insulin resistance in a community-based sample. A cross-sectional analysis that included 3,310 participants from the Sleep Heart Health Study was undertaken (53% female; mean age, 66.1 yr). Full montage home-polysomnography and fasting glucose were available on all participants. SDB severity during REM and non-REM sleep was quantified using the apnea-hypopnea index in REM (AHIREM) and non-REM sleep (AHINREM), respectively. Fasting and 2-hour post-challenge glucose levels were assessed during a glucose tolerance test (n = 2,264). The homeostatic model assessment index for insulin resistance (HOMA-IR) was calculated (n = 1,543). Linear regression was used to assess the associations of AHIREM and AHINREM with fasting and post-prandial glucose levels and HOMA-IR. AHIREM and AHINREM were associated with fasting glycemia, post-prandial glucose levels, and HOMA-IR in models that adjusted for age, sex, race, and site. However, with additional adjustment for body mass index, waist circumference, and sleep duration, AHIREM was only associated with HOMA-IR (β = 0.04; 95% CI, 0.1-0.07; P = 0.01), whereas AHINREM was only associated with fasting (β = 0.93; 95% CI, 0.14-1.72; P = 0.02) and post-prandial glucose levels (β = 3.0; 95% CI, 0.5-5.5; P = 0.02). AHIREM is associated with insulin resistance but not with fasting glycemia or glucose intolerance.

Secretion of glucagon and glucagon-like peptide-1 in different glucose tolerance status during pregnancy

Objective To evaluate the clinical and biochemical characteristics of pregnant women with different glucose tolerance status, and their secretion characteristics of insulin, glucagon and glucagon-like peptide-1 (GLP-1)after oral glucose challenge. Methods We analyzed 74 cases pregnant women with positive results of 50 g glucose challenge test in 24-28 gestational weeks, who received regular obstetrical follow-up in Peking Union Medical College Hospital from January 2009 to June 2012. A further 100 g oral glucose tolerance test (OGTT) was performed, based on which the included women were divided into three groups, namely gestational diabetes mellitus (GDM) group (n=25), impaired glucose tolerance (IGT) group (n=25) and normal glucose tolerance (NGT) group (n=24). The general clinical data and biochemical indexes of the three groups were compared, and the indexes about insulin resistance and the function of pancreatic islet beta cells were calculated. Glucose, insulin, glucagon and GLP-1 were measured in OGTT. The secretion characteristics of each of these hormones and their correlation with other indicators were evaluated. Results Compared with the NGT group, the GCT[(9.21±0.75) mmol/L vs.(8.52±0.50) mmol/L, P<0.05] and glycosylated hemoglobin A1c [(5.39±0.34)% vs.(5.18±0.20)%, P<0.05]were significantly higher in the GDM group. In OGTT, the area under curve (AUC) of glucose in the GDM group was significantly higher than that in the IGT group and NGT group[(26.58±2.02)mmol/(L·h) vs.(23.20±1.51) mmol/(L·h), (26.58±2.02)mmol/(L·h) vs.(19.84±1.95) mmol/(L·h), both P<0.05]. The peak values of insulin secretion in the GDM group and IGT group were delayed to 2 hours after OGTT.The 3-hour insulin level in the GDM group was significantly higher than that in the NGT group(P<0.05). Compared with the NGT group, the glucagon levels in each time point after OGTT and the AUC of glucagon levels were reduced in the GDM group and the IGT group, but with no significant differences. The peak glucagon levels in the 3 groups all appeared at 3 hours after OGTT. The GLP-1 levels in each time point of OGTT were gradually increased from the NGT group to the IGT group to the GDM group, but no significant differences were found. The peak value of GLP-1 level was presented at 1 hour after OGTT in the NGT group and the IGT group and at 2 hours after OGTT in the GDM group. The valley values of GLP-1 level in the 3 groups all appeared at 3 hours after OGTT. In comparison with the NGT group, the ratios of GLP-1 to blood glucose levels (GLP/BG) at 1-hour and 2-hour were significantly decreased in the GDM group (P<0.05). The AUC of glucagon levels in OGTT were negatively correlated with fasting blood glucose(r=-0.287, P=0.013) and 1-hour glucose levels(r=-0.266, P=0.022) in OGTT and positively correlated with insulin secretion sensitivity index(ISSI) (r=0.297, P=0.010) and HOMA-β(r=0.236, P=0.043). Moreover, the AUC of GLP-1 levels in OGTT was negatively correlated with the levels of C-reactive protein (r=-0.264, P=0.035). The AUC of GLP/BG in OGTT was positively correlated with ISSI (r=0.406, P<0.001). Conclusions Pregnant women with GDM and IGT in the second trimester have insulin resistance and dysfunction of pancreatic islet β cells.Potential GLP-1 resistance and inadequate secretion may exist in GDM patients. GLP/BG may be a better parameter to evaluate the secretion function of L cells in pregnancy and an effective parameter to estimate the compensatory function of pancreatic β cells indirectly.Glucagon levels may not start to change obviously before 28 gestational weeks. Key words: Gestational diabetes mellitus; Insulin resistance; Glucagon; Glucagon-like peptide-1

Utility of the Oral Glucose Tolerance Test to Assess Glucose Abnormalities in Adolescents with Polycystic Ovary Syndrome

Study ObjectiveThe aim of this study was to examine the prevalence of and risk factors for abnormal glucose metabolism in a large population of adolescents with polycystic ovary syndrome (PCOS). Design, Setting, Participants, Interventions, and Main Outcome MeasuresA retrospective chart review was performed of 360 patients who presented to the pediatric gynecology outpatient clinic for evaluation of PCOS between January 2004 and May 2012. ResultsA total of 163 patients fulfilled criteria for a diagnosis of PCOS and had adequate clinical and laboratory data. Twenty-six adolescents (16.0%) had impaired glucose tolerance and 2 patients (1.2%) met criteria for a provisional diagnosis of type 2 diabetes. All 28 subjects with abnormal glucose metabolism were identified using the 2-hour plasma glucose of the oral glucose tolerance test. Conversely, the fasting glucose values only successfully detected 2 patients with hyperglycemia, both of whom also had abnormal 2-hour glucose levels. Adolescents with abnormal glucose metabolism were more likely to have reported a positive family history (P = .02) and had higher body mass index z scores (2.8 ± 1.1 vs 1.8 ± 1.2; P < .01). When patients were classified into normal weight (n = 29) and obese/overweight groups (n = 117), all of the patients with abnormal glucose metabolism were overweight or obese. ConclusionIn the largest series to date, we describe a prevalence of abnormal glucose metabolism in adolescent patients with PCOS of 17.2%. Abnormal glucose metabolism is associated with many of the known risk factors for metabolic syndrome. Our results support that the oral glucose tolerance test is a superior diagnostic test to assess abnormal glucose levels in overweight and obese adolescents but that this test might have limited utility in normal weight adolescents with PCOS.

Outcomes of Pregnancy After Bariatric Surgery

Maternal obesity is associated with increased risk of pregnancy complications such as gestational diabetes, stillbirth, preterm birth, and congenital malformations. While small studies have looked into the effect of prepregnancy bariatric surgery on gestational diabetes, these studies have been inconclusive and have not considered presurgery body mass index (BMI) as a confounder. Some systematic reviews have found a lower risk of neonatal complications after bariatric surgery but included heterogeneous studies with small sample sizes. Taking presurgery BMI into account, this study aims to investigate the risks of adverse perinatal outcomes including gestational diabetes in women who have had bariatric surgery versus women who have not. This population-based study used data from Swedish registries nationwide, which include prenatal, obstetric, and neonatal records. Of 627,693 singleton pregnancies between 2006 and 2011, 670 were in women who had undergone bariatric surgery with presurgery weight documented. Up to 5 control pregnancies in obese women were matched for BMI, age, level of education, years, and smoking history for each pregnancy in the intervention cohort. For controls, weight during early pregnancy was used to calculate BMI. For the study group, BMI was calculated with weight and height measurements at the time of surgery. Outcomes included gestational diabetes, low birth weight, macrosomia, stillbirth, large- and small-for-gestational-age, preterm birth, neonatal death, and major congenital malformations detected during the first year of life. Gestational diabetes was diagnosed by a 2-hour plasma glucose level of 10.0 mmol/L or higher during a glucose tolerance test (with a 75-g loading dose) or a fasting plasma glucose level of 7.0 mmol/L or higher. In the study, 1.9% of the postsurgery pregnancies versus 6.8% of the control pregnancies had gestational diabetes (odds ratio, 0.25; 95% confidence interval [CI], 0.13–0.47; P < 0.001; Table 2). The median gestation time of the diagnosis was 32 weeks for both groups, considering women for whom the diagnosis date was available. The surgery cohort, compared with controls, was associated with an increased risk of small-for-gestational-age infants (15.6% vs 7.6%; odds ratio, 2.20; 95% CI, 1.64–2.95; P < 0.001) and increased risk for low birth weight, although that was not statistically significant (6.8% vs 4.5%; odds ratio, 1.34; 95% CI, 0.88–2.04; P = 0.17). Alternatively, the surgery group had a lower risk for large-for-gestational-age infants compared with the control group (8.6% vs 22.4%; odds ratio, 0.33; 95% CI, 0.24–0.44; P < 0.001) and lower risk of macrosomia (1.2% vs 9.5%; odds ratio, 0.11; 95% CI, 0.05–0.24; P < 0.001). There was no significant difference between the 2 groups in terms of risk of preterm birth (10.0% vs 7.5%; odds ratio, 1.28; 95% CI, 0.92–1.78; P = 0.15), nor in terms of congenital malformations. One limitation of this study was that nearly all (98%) of the surgery procedures were gastric bypass surgery, so it is not clear as to whether these findings apply to other types of bariatric surgery. While the study found that bariatric surgery was associated with reduced risks of large-for-gestational-age infants as well as gestational diabetes, bariatric surgery was also associated with increased odds of small-for-gestational age infants, so increased attention during these pregnancies is recommended.

Effects on type 2 diabetes complicated with pulmonary tuberculosis: regiment of insulin, isoniazid, rifampicin, pyrazinamide and ethambutol versus the regiment plus Qi-boosting and Yin-nourishing decoction of Traditional Chinese Medicine

ObjectiveTo observe the clinical effect on type 2 diabetes mellitus (T2DM) complicated with pulmonary tuberculosis (TB) of insulin, isoniazid, rifampicin, pyrazinamide and ethambutol (conventional medication) administered together with Qi-boosting and yin-nourishing decoction derived from Traditional Chinese Medicine (TCM) MethodsA total of 60 patients with T2DM complicated with pulmonary TB were randomly and equally divided into positive control group and treatment group. The control group was treated with Western conventional regiment (WCR): insulin, isoniazid, rifampicin, pyrazinamide, and ethambutol, whereas the treatment group was given both WCR and Qi-boosting and yin-nourishing decoction prepared from TCM. ResultsAfter the treatment, 20 (66.7%) and 11 (36.7%) cases showed sputum bacteria negative conversion in the WCR plus TCM group and WCM group respectively (P < 0.05). A total of 25 (83.3%) and 18 (60%) cases showed improvement in lung lesion in the WCR plus TCM group and WCM group respectively (P < 0.05). Compared with WCR group, fasting plasma glucose and 2-hour postprandial blood glucose levels in the WCR plus TCM group significantly decreased (P < 0.05 and P < 0.01, respectively). ConclusionsQi-boosting and yin-nourishing decoction combined with the Western medication showed better curative effect in treating T2DM complicated with pulmonary TB compared with the group using the conventional Western medicine alone.

Change in Intra-Abdominal Fat Predicts the Risk of Hypertension in Japanese Americans.

In Japanese Americans, intra-abdominal fat area measured by computed tomography is positively associated with the prevalence and incidence of hypertension. Evidence in other populations suggests that other fat areas may be protective. We sought to determine whether a change in specific fat depots predicts the development of hypertension. We prospectively followed up 286 subjects (mean age, 49.5 years; 50.4% men) from the Japanese American Community Diabetes Study for 10 years. At baseline, subjects did not have hypertension (defined as blood pressure ≥140/90 mm Hg) and were not taking blood pressure or glucose-lowering medications. Mid-thigh subcutaneous fat area, abdominal subcutaneous fat area, and intra-abdominal fat area were directly measured by computed tomography at baseline and 5 years. Logistic regression was used to estimate odds of incident hypertension over 10 years in relation to a 5-year change in fat area. The relative odds of developing hypertension for a 5-year increase in intra-abdominal fat was 1.74 (95% confidence interval, 1.28-2.37), after adjusting for age, sex, body mass index, baseline intra-abdominal fat, alcohol use, smoking status, and weekly exercise energy expenditure. This relationship remained significant when adjusted for baseline fasting insulin and 2-hour glucose levels or for diabetes mellitus and pre-diabetes mellitus classification. There were no significant associations between baseline and change in thigh or abdominal subcutaneous fat areas and incident hypertension. In conclusion, in this cohort of Japanese Americans, the risk of developing hypertension is related to the accumulation of intra-abdominal fat rather than the accrual of subcutaneous fat in either the thigh or the abdominal areas.

Role of Physical Activity Energy Expenditure versus Estimated Fitness Level in Impaired Glucose Regulation

Physical activity and exercise are beneficial for glucose regulation, but little is known about the relative roles of physical activity energy expenditure (PAEE) versus cardiorespiratory fitness (CRF) in glucose regulation. PURPOSE: To examine the associations of PAEE and CRF with markers of glucose metabolism, and to test the hypothesis that CRF modifies the association between PAEE and glucose metabolism. METHODS: We analyzed cross-sectional data from the Danish ADDITION-PRO study, including 755 adults aged 45-80 y with low-to-high diabetes risk. All participants had a 75 g oral glucose tolerance test with venous glucose and insulin concentrations measured at 0, 30 and 120 min. Markers of insulin sensitivity and beta cell function were calculated. PAEE (kJ·kg−1·d−1) was measured using a combined heart rate and movement sensor. CRF (maximal oxygen uptake, ml O2·kg−1·min−1) was estimated using a sub-maximal 8-min step test. The associations were examined by linear regression analysis adjusted for age, sex, smoking status, alcohol intake, and waist circumference. Interaction between CRF and PAEE on glucose metabolism was examined. RESULTS: Both PAEE and CRF were lower in impaired glucose tolerance (median (IQR) PAEE: 26.6 (18.9;35.8); CRF: 27.9 (24.3;30.3); P≤0.004) and screen-detected diabetes (PAEE: 28.0 (19.8;36.8); CRF: 28.5 (26.1;30.9); P≤0.003), but unchanged in impaired fasting glucose (PAEE: 30.9 (22.5;41.4); CRF: 29.5 (26.2;32.8); P=0.488) as compared with normal glucose tolerant individuals (PAEE: 32.0 (23.1;44.5); CRF: 29.9 (26.8;34.2)). Both PAEE and CRF were associated with higher insulin sensitivity and beta cell function (P<0.05). When adjusting CRF for PAEE and vice versa, CRF was still associated with lower fasting and 2-hour glucose levels as well as higher insulin sensitivity and beta cell function, but PAEE was only significantly associated with higher insulin sensitivity. There was no interaction between CRF and PAEE on any markers of glucose metabolism (P≥0.05 for all). CONCLUSIONS: PAEE and CRF are both associated with insulin sensitivity, but only CRF is independently associated with blood glucose levels and beta cell function. These findings suggest that long-term accumulation of PAEE and/or the intensity of PAEE are particularly important for glucose regulation.

Endocannabinoid system activation may be associated with insulin resistance in women with polycystic ovary syndrome

To assess the levels of endocannabinoids and cannabinoid receptors (CB) 1 and 2 in women with polycystic ovary syndrome (PCOS). Case-control study. University teaching hospital. In total, 20 women with PCOS and 20 healthy women in a control group, who were matched for body mass index and age, were enrolled in this study. The homeostasis model index was used to assess insulin resistance. Omental adipose tissue and human peripheral blood mononuclear cells (PBMCs) from PCOS and the controls were analyzed using real-time polymerase chain reactions for the expressions of CB1 and CB2. The levels of endocannabinoids were analyzed using high-performance liquid chromatography. The levels of anandamide and 2-arachidonoylglycerol, and the expression of CB1 and CB2 mRNA (messenger ribonucleic acid) in the PBMCs were significantly higher in the women with PCOS than in the women serving as controls. We found that expression of CB1, but not CB2, in adipose tissue was significantly higher in the women with, vs. without, PCOS. The expressions of CB1 mRNA and endocannabinoids showed a significant positive correlation with 2-hour glucose and insulin levels 2hours after glucose loading in the PBMCs and adipose tissue. Activation of endocannabinoids and overexpression of cannabinoid receptors, especially CB1, may be associated with insulin resistance in women with PCOS.

Anthropometric parameters and their associations with cardio-metabolic risk in Chinese working population.

BackgroundThere remains controversy regarding which of the anthropometric indicators best defines obesity. In this study, we compared the efficacy of using body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) in the diagnosis of obesity and assessed their associations with diabetes, hypertension, and dyslipidemia in an urban working population in China.MethodsAnthropometric measurements, blood pressure, plasma lipids, fasting and 2-hour plasma glucose (PG) levels by a 75 gram oral glucose tolerance test (OGTT) were obtained from 2603 working Chinese who had no history of cardiovascular diseases or diabetes. Cardio-metabolic risk factors including high blood pressure, dyslipidemia, and glucose intolerance were evaluated. The diagnoses of overweight and obesity were based on the WHO definitions with BMI for general obesity and WC and WHR for central obesity.ResultsBased on BMI, WC and WHR, there were 31.3%, 16.6%, 35.2% of the studied subjects, respectively, being overweight and 2.0%, 5.6%, 9.2% being obese. Among women but not men, more overweight and obese subjects were diagnosed using WHR and WC. The number of cardio-metabolic risks was higher by WC criterion than BMI and WHR in the whole group (p <0.05) and female subjects (p <0.01). Comparing the three anthropometric indexes predicting hypertension, hyperglycemia, dyslipidemia and multiple cardio-metabolic risks, for women, it was WC having the largest areas under ROC curves (0.759, 0.746, 0.701 and 0.773 respectively); while in men, it was WC for hypertension, WHR for hyperglycemia, BMI for dyslipidemia and WC for multiple cardio-metabolic risks (areas under ROC curves were 0.658, 0.686, 0.618 and 0.695 respectively).ConclusionsAmong Chinese working population, the need of lower cutoff values to define overweight and obesity were observed. Central obesity indicator (WC) is the preferred measure to predict the presence of cardio-metabolic risk in Chinese female subjects.

Resistance Training Improves Hyperglycemia and Dyslipidemia, Highly Prevalent Among Nonelderly, Nondiabetic, Chronically Disabled Stroke Patients

ObjectiveTo test the effect of 8 weeks of lower body resistance training on hyperglycemia and dyslipidemia, which may be prevalent among nonelderly, nondiabetic, chronically disabled stroke patients. DesignRandomized controlled study. SettingOutpatient clinics of rehabilitation centers. ParticipantsNonelderly, nondiabetic, chronically disabled stroke subjects (N=56) were enrolled and randomly assigned to an experimental group (n=28) and a control group (n=28). InterventionsLower body resistance training was performed by subjects in the experimental group 3 times a week for 8 weeks. The control group was given duration-matched stretch exercises. Main Outcome MeasuresFasting glucose level, fasting insulin level, 2-hour blood glucose level during oral glucose tolerance test, homeostasis model assessment of insulin resistance (HOMA-IR), glycosylated hemoglobin (Hb A1c), total triglyceride level, total cholesterol level, high-density lipoprotein (HDL) cholesterol level, low-density lipoprotein (LDL) cholesterol level, body mass index, lower limb muscle strength, and Fugl-Meyer motor score. ResultsBefore the intervention, 34 subjects (60.7%) had hyperglycemia and 38 (67.9%) had dyslipidemia. Fifty-one subjects finished the study. Subjects in the experimental group (n=26) showed significant improvements in fasting insulin and 2-hour blood glucose levels; HOMA-IR; total cholesterol, HDL cholesterol, and LDL cholesterol levels; and muscle strength compared with control subjects (n=25) after the intervention (P<.05). ConclusionsResistance training may play a significant role in improving hyperglycemia and dyslipidemia, which are frequently present among nonelderly, nondiabetic, chronically disabled stroke patients.

Association between the Postprandial Glucose Levels and Arterial Stiffness Measured According to the Cardio-ankle Vascular Index in Non-diabetic Subjects.

Although a relationship between post-challenge hyperglycemia and arterial stiffness has been reported, the relationship between the postprandial glucose levels and cardio-ankle vascular index (CAVI) in non-diabetic subjects is not clear. This study thus evaluated the association between the postprandial glucose levels after a composite meal and the degree of arterial stiffness measured according to CAVI in non-diabetic subjects. The subjects included 1,291 individuals (655 men and 636 women; mean age, 48.6 years; range, 23-85 years) who underwent medical examinations, including blood tests and CAVI assessments, between October 2005 and April 2012. The 1-hour postprandial glucose levels were determined after a 600-kcal traditional Japanese meal. The CAVI values were significantly higher in the subjects with higher 1-hour postprandial glucose levels (≥140 mg/dL in men; ≥158 mg/dL in women). A simple regression analysis indicated that the CAVI values were significantly correlated with the 1-hour postprandial glucose levels in men (r=0.286, p<0.0001) and women (r=0.228, p<0.0001). After adjusting for age, BMI, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, 1-hour postprandial glucose, homeostatis model assessment of insulin resistance, estimated glemerular filtration rate, and high sensitive C-reactive protein, stepwise multiple regression analysis demonstrated that the 1-hour postprandial glucose level was an independent predictor associated with the CAVI in men (p=0.003) and older women 50 years of age or older (p=0.003). This study demonstrated that the 1-hour postprandial glucose levels are associated with increased CAVI values in non-diabetic men and older women 50 years of age or older.

Response: Normal Glucose Tolerance with a High 1-Hour Postload Plasma Glucose Level Exhibits Decreased β-Cell Function Similar to Impaired Glucose Tolerance (Diabetes Metab J 2015;39:147-53).

A 75-g oral glucose tolerance test (OGTT) is a sensitive test in most populations for diagnosis of type 2 diabetes mellitus (T2DM) and commonly used to identify high-risk individuals of T2DM [1]. The diagnostic criteria define diabetes as a fasting glucose ≥126 mg/dL or a 2-hour glucose challenge ≥200 mg/dL, but not including 1-hour glucose level. Recently, data obtained in population studies have suggested that 1-hour glucose level after OGTT can provide a better predictor for development of T2DM than fasting or 2-hour glucose [2]. And, subjects with 1-hour glucose levels of ≥155 mg/dL with normal glucose tolerance (NGT 1-hour high) have been considered as high risk of T2DM [3], which were more insulin-resistant and worse β-cell function than subjects with NGT 1 hour-low (<155 mg/dL) [4].