2-hour Glucose Levels Research Articles

Association Between Glucose Tolerance Level and Cancer Death in a General Japanese Population: The Hisayama Study

The authors examined the associations of glucose tolerance status and fasting and 2-hour postload glucose levels with the risk of cancer death in a 19-year follow-up study of 2,438 Japanese subjects aged 40-79 years who underwent a 75-g oral glucose tolerance test (1988-2007). During follow-up, 229 subjects died of cancer. The risk of cancer death was significantly higher in subjects with fasting plasma glucose levels of ≥5.6 mmol/L or 2-hour postload glucose levels of ≥11.1 mmol/L than in those with the lowest fasting or 2-hour postload glucose levels, after adjustment for potentially confounding factors. According to glucose tolerance status, not only diabetes but also impaired fasting glycemia and impaired glucose tolerance were significant risk factors for cancer death (for impaired fasting glycemia, multivariable-adjusted hazard ratio (HR) = 1.49 (95% confidence interval (CI): 1.05, 2.11); for impaired glucose tolerance, HR = 1.52 (95% CI: 1.05, 2.22); and for diabetes, HR = 2.10 (95% CI: 1.41, 3.12)). With regard to site-specific cancers, elevated fasting or 2-hour postload glucose levels were associated with the risks of death from stomach, liver, and lung cancer. These findings suggest that both prediabetic hyperglycemia and diabetes are significant risk factors for cancer death in the general Japanese population.

Arsenic exposure, diabetes prevalence, and diabetes control in the Strong Heart Study.

This study evaluated the association of arsenic exposure, as measured in urine, with diabetes prevalence, glycated hemoglobin, and insulin resistance in American Indian adults from Arizona, Oklahoma, and North and South Dakota (1989-1991). We studied 3,925 men and women 45-74 years of age with available urine arsenic measures. Diabetes was defined as a fasting glucose level of 126 mg/dL or higher, a 2-hour glucose level of 200 mg/dL or higher, a hemoglobin A1c (HbA1c) of 6.5% or higher, or diabetes treatment. Median urine arsenic concentration was 14.1 µg/L (interquartile range, 7.9-24.2). Diabetes prevalence was 49.4%. After adjustment for sociodemographic factors, diabetes risk factors, and urine creatinine, the prevalence ratio of diabetes comparing the 75th versus 25th percentiles of total arsenic concentrations was 1.14 (95% confidence interval: 1.08, 1.21). The association between arsenic and diabetes was restricted to participants with poor diabetes control (HbA1c ≥8%). Arsenic was positively associated with HbA1c levels in participants with diabetes. Arsenic was not associated with HbA1c or with insulin resistance (assessed by homeostatic model assessment to quantify insulin resistance) in participants without diabetes. Urine arsenic was associated with diabetes control in a population from rural communities in the United States with a high burden of diabetes. Prospective studies that evaluate the direction of the relation between poor diabetes control and arsenic exposure are needed.

Association of Common Genetic Variants in the MAP4K4 Locus with Prediabetic Traits in Humans

Mitogen-activated protein kinase kinase kinase kinase 4 (MAP4K4) is expressed in all diabetes-relevant tissues and mediates cytokine-induced insulin resistance. We investigated whether common single nucleotide polymorphisms (SNPs) in the MAP4K4 locus associate with glucose intolerance, insulin resistance, impaired insulin release, or elevated plasma cytokines. The best hit was tested for association with type 2 diabetes. Subjects (N = 1,769) were recruited from the Tübingen Family (TÜF) study for type 2 diabetes and genotyped for tagging SNPs. In a subgroup, cytokines were measured. Association with type 2 diabetes was tested in a prospective case-cohort study (N = 2,971) derived from the EPIC-Potsdam study. Three SNPs (rs6543087, rs17801985, rs1003376) revealed nominal and two SNPs (rs11674694, rs11678405) significant associations with 2-hour glucose levels. SNPs rs6543087 and rs11674694 were also nominally associated with decreased insulin sensitivity. Another two SNPs (rs2236936, rs2236935) showed associations with reduced insulin release, driven by effects in lean subjects only. Three SNPs (rs11674694, rs13003883, rs2236936) revealed nominal associations with IL-6 levels. SNP rs11674694 was significantly associated with type 2 diabetes. In conclusion, common variation in MAP4K4 is associated with insulin resistance and β-cell dysfunction, possibly via this gene’s role in inflammatory signalling. This variation’s impact on insulin sensitivity may be more important since its effect on insulin release vanishes with increasing BMI.

A 12-week exercise program performed during the second trimester does not prevent gestational diabetes in healthy pregnant women

Does a 12-week exercise program prevent gestational diabetes and improve insulin resistance in healthy pregnant women with normal body mass index (BMI)? Randomised, controlled trial with concealed allocation and blinded outcome assessment. Two University hospitals in Norway. White adult women with a single fetus. High-risk pregnancies or diseases that would interfere with participation were exclusion criteria. Randomisation of 855 participants allocated 429 to the exercise group and 426 to a control group. Both groups received written advice on pelvic floor muscle exercises, diet, and lumbo-pelvic pain. In addition, the intervention group participated in a standardised group exercise program led by a physiotherapist, once a week for 12 weeks, between 20 and 36 weeks gestation. The program included 30-35 minutes low impact aerobics, 20-25 minutes of strength exercises using body weight as resistance and 5-10 minutes of stretching, breathing, and relaxation exercises. They were also encouraged to follow a 45-minute home exercise program at least twice a week. The control group received standard antenatal care and the customary information given by their midwife or general practitioner. The primary outcomes were the prevalence of gestational diabetes, insulin resistance estimated by the homeostasis model assessment method (HOMA-IR), and fasting insulin and oral glucose tolerance tests at baseline and at the end of the training period. Fasting and 2-hour glucose levels were measured in serum by the routine methods. Gestational diabetes was diagnosed as fasting glucose level 2-hour value ≥7.8mmol/L. Secondary outcome measures were weight, BMI, and pregnancy complications and outcomes. 702 participants completed the study. At the end of the 12-week program, there was no difference in the prevalence of gestational diabetes (25 (7%) of intervention group compared with 18 (6%) of control group), HOMA-IR (-0.15, 95% CI -0.33 to 0.03), or oral glucose tolerance tests at 2 hours (-0.13mmol/L, 95% CI -0.28 to 0.03) between the groups. Fasting insulin was significantly lower in the intervention group by 1.0 international units/mL (95% CI -0.1 to -1.9). The groups did not differ significantly on any of the secondary outcomes. Adherence to the exercise protocol in the intervention group was 55%. A per protocol analysis of 217 women in the intervention group who adhered to the exercise program demonstrated similar results with no difference in prevalence of diabetes. A 12-week exercise program undertaken during the second trimester of pregnancy did not reduce the prevalence of gestational diabetes in pregnant women with BMI in the normal range.

Clinical Effects of Colesevelam in Hispanic Subjects with Primary Hyperlipidemia and Prediabetes

Objective: To evaluate the efficacy and safety of colesevelam in Hispanic subjects with primary hyperlipidemia and prediabetes. Materials and Methods: A 16-week, randomized, double–blind, placebo–controlled, multinational study evaluating colesevelam in participants with primary hyperlipidemia (low–density lipoprotein cholesterol [LDL–C] level ≥ 100 mg/dL) and prediabetes (fasting plasma glucose level ≥ 110 to ≤ 125 mg/dL, or 2-hour postload glucose level ≥ 140 to < 200 mg/dL during an oral glucose tolerance test) was conducted between January 14, 2008 and April 3, 2009. Participants were randomized 1:1 to colesevelam 3.75 g/day or placebo. The primary efficacy endpoint was mean change from baseline in LDL–C level with colesevelam compared with placebo. Participants who self–identified as Hispanic during enrollment were included in this exploratory analysis evaluating the efficacy of colesevelam in Hispanics with primary hyperlipidemia and prediabetes. Results: From a total of 216 subjects with primary hyperlipidemia and prediabetes, 153 Hispanics were included in this post hoc analysis; 77 subjects were randomized to colesevelam and 76 subjects were randomized to placebo. At week 16, LDL–C levels were significantly reduced with colesevelam compared with placebo (mean treatment difference, −19.4%; P < 0.0001). Achievement of LDL–C level < 100 mg/dL was more frequent with colesevelam than with placebo (27% vs 11%; P = 0.002). In addition, significant mean reductions in non–high–density lipoprotein cholesterol, total cholesterol, and apolipoprotein B levels (P ≤ 0.0002 for all), and a significant median increase in triglyceride levels (P = 0.003), were seen with colesevelam compared with placebo. At study end, there was a significant mean reduction in glycated hemoglobin levels and median reduction in fasting plasma glucose levels with colesevelam compared with placebo (P ≤ 0.02 for both). A fasting plasma glucose level < 100 mg/dL was achieved in 44% of colesevelam recipients compared with 23% of placebo recipients (P < 0.05). Overall, colesevelam was well tolerated. Conclusion: Colesevelam may be a treatment option for Hispanic subjects with primary hyperlipidemia and prediabetes, mainly to reduce LDL–C levels, with added beneficial effect on glucose levels.

Does Insulin Resistance Drive the Association between Hyperglycemia and Cardiovascular Risk?

BackgroundSeveral studies have shown associations between hyperglycemia and risk of cardiovascular disease (CVD) and mortality, yet glucose-lowering treatment does little to mitigate this risk. We examined whether associations between hyperglycemia and CVD risk were explained by underlying insulin resistance.MethodsIn 60 middle-aged individuals without diabetes we studied the associations of fasting plasma glucose, 2-hour post oral glucose tolerance test plasma glucose, insulin sensitivity as well as body fat percentage with CVD risk. Insulin sensitivity was measured as the glucose infusion rate during a euglycemic hyperinsulinemic clamp, body fat percentage was measured by dual X-ray absorptiometry, and CVD risk was estimated using the Framingham risk score. Associations of fasting plasma glucose, 2-hour plasma glucose, insulin sensitivity and body fat percentage with the Framingham risk score were assessed in linear regression models.ResultsBoth fasting and 2-hour plasma glucose levels were associated with higher Framingham risk score (fasting glucose: r2 = 0.21; 2-hour glucose: r2 = 0.24; P<0.001 for both), and insulin sensitivity with lower Framingham risk score (r2 = 0.36; P<0.001). However, adjustment for insulin sensitivity and 2-hour glucose made the effect of fasting glucose non-significant (P = 0.060). Likewise, when adjusting for insulin sensitivity and fasting glucose, the association between 2-hour glucose and Framingham risk score disappeared (P = 0.143). In contrast, insulin sensitivity was still associated with Framingham risk score after adjusting for glucose levels (P<0.001). Body fat was not associated with Framingham risk score when taking insulin sensitivity into account (P = 0.550).ConclusionThe association between plasma glucose levels and CVD risk is mainly explained by insulin resistance, which raises the question of whether glucose lowering per se without changes in the processes that underlie hyperglycemia should be the sole clinical paradigm in the treatment of type 2 diabetes or its prevention.

Detection of Prediabetes and Undiagnosed Type 2 Diabetes: A Large Population-Based Study

ObjectivePrediabetes and undiagnosed diabetes have been commonly ignored. We aimed to investigate the prevalence of prediabetes and undiagnosed type 2 diabetes mellitus, and to verify the hypothesis that vascular risk factors (VRFs) may indicate prediabetes and undiagnosed type 2 diabetes. MethodsA total of 7567 adults, who were 20 to 79 years of age, and living in Tianjin, China, participated in this study. Type 2 diabetes was assessed based on medical history, hypoglycemic drugs use, fasting plasma glucose level ≥7.0 mmol/L, or postprandial 2-hour plasma glucose level ≥11.1 mmol/L. Undiagnosed type 2 diabetes was defined among subjects with type 2 diabetes when neither a medical history of diabetes nor hypoglycemic drugs use was present. Prediabetes was ascertained as fasting plasma glucose level of 6.1 to 6.9 mmol/L, or postprandial 2-hour plasma glucose level of 7.8 to 11.0 mmol/L (WHO 1999) among diabetes-free participants. Data were analyzed using multinomial logistic regression with adjustment for potential confounders. ResultsOf all participants, 655 (8.7%) had prediabetes, and 721 (9.5%) were patients with type 2 diabetes, including 321 (4.2%) undiagnosed type 2 diabetes accounting for 44.5% patients with diabetes. The prevalence of prediabetes and undiagnosed type 2 diabetes increased with age, and was higher in women than in men. In a fully adjusted multinomial logistic regression model, hypertension, overweight, obesity, central obesity, and family history of diabetes were significantly associated with prediabetes and undiagnosed diabetes, whereas physical inactivity was independently related to undiagnosed diabetes. ConclusionThe prevalence of prediabetes and undiagnosed diabetes is approximately 13%, and almost 45% of patients with diabetes are undiagnosed. VRFs, such as hypertension, high adiposity, and family history of diabetes can be indicators for detecting prediabetes and undiagnosed diabetes.

Vitamin D Deficiency in Obese Children and Its Relationship to Glucose Homeostasis

Obesity in adults and children is associated with high rates of vitamin D deficiency. The relationship of mechanisms of glucose homeostasis to this association is poorly understood. This cross-sectional study was designed to compare the prevalence of vitamin D deficiency in obese and nonoverweight children in North Texas, and also to examine the association between dietary habits and serum 25-hydroxyvitamin D (25(OH)D) levels and correlations between 25(OH)D levels and markers of glucose homeostasis and blood pressure in obese children. The clinical parameters examined included serum 25(OH)D, dietary information, homeostasis model assessment of insulin resistance, 2-hour glucose from oral glucose tolerance test, hemoglobin A1c, fasting glucose and insulin, and systolic and diastolic blood pressures. Participants were 411 obese subjects (aged 6–16 years) examined at an obesity referral clinic. Levels of 25(OH)D also were measured in 87 matched control nonoverweight subjects (aged 6–16 years). Obese subjects with a 25(OH)D level below 50 nmol/L were considered to be vitamin D deficient, and those with a level below 75 nmol/L were classified as vitamin D insufficient. More than 90% of obese subjects were vitamin D insufficient (25(OH)D level <75 nmol/L) and 50% were vitamin D deficient (25(OH)D level <50 nmol/L). Significantly fewer control subjects were vitamin D insufficient or deficient (both P < 0.01 compared with obese subjects). A negative association was found between 25(OH)D levels and the dietary measures of soda intake, juice intake, and skipping breakfast (each comparison P < 0.001). After adjustment for body mass index and age, 25(OH)D levels were negatively correlated with homeostasis model assessment of insulin resistance (r = −0.19; P = 0.001) and 2-hour glucose (r = −0.12; P = 0.04. There was no correlation between 25(OH)D and hemoglobin A1c, systolic blood pressure Z score, or diastolic blood pressure Z score. These findings show that vitamin D deficiency is significantly more prevalent in a population of obese children than in nonoverweight children. The inverse association between 25(OH)D levels with both insulin resistance and 2-hour glucose levels suggest that low 25(OH)D levels may play a role in the pathophysiology of impaired glucose tolerance or type 2 diabetes in obese children.

Effects of a culturally grounded community-based diabetes prevention program for obese Latino adolescents.

The purpose of this study was to test the feasibility and preliminary effects of a culturally grounded, community-based diabetes prevention program among obese Latino adolescents. Fifteen obese Latino adolescents (body mass index [BMI] percentile = 96.3 ± 1.1, age = 15.0 ± 0.9 years) completed a 12-week intervention that included weekly lifestyle education classes delivered by bilingual/bicultural promotoras and three, 60-minute physical activity sessions per week. Participants were assessed for anthropometrics (height, weight, BMI, and waist circumference), cardiorespiratory fitness, physical activity/inactivity, nutrition behaviors, and insulin sensitivity and glucose tolerance by a 2-hour oral glucose tolerance test. The intervention resulted in significant decreases in BMI z score, BMI percentile, and waist circumference; increases in cardiorespiratory fitness; and decreases in physical inactivity and dietary fat consumption. In addition to these changes, the intervention led to significant improvements in insulin sensitivity and reductions in 2-hour glucose levels. These results support the feasibility and efficacy of a community-based diabetes prevention program for high-risk Latino youth. Translational approaches that are both culturally grounded and biologically meaningful represent a novel and innovative strategy for closing the obesity-related health disparities gap.

No interactions between previously associated 2-hour glucose gene variants and physical activity or BMI on 2-hour glucose levels.

Gene–lifestyle interactions have been suggested to contribute to the development of type 2 diabetes. Glucose levels 2 h after a standard 75-g glucose challenge are used to diagnose diabetes and are associated with both genetic and lifestyle factors. However, whether these factors interact to determine 2-h glucose levels is unknown. We meta-analyzed single nucleotide polymorphism (SNP) × BMI and SNP × physical activity (PA) interaction regression models for five SNPs previously associated with 2-h glucose levels from up to 22 studies comprising 54,884 individuals without diabetes. PA levels were dichotomized, with individuals below the first quintile classified as inactive (20%) and the remainder as active (80%). BMI was considered a continuous trait. Inactive individuals had higher 2-h glucose levels than active individuals (β = 0.22 mmol/L [95% CI 0.13–0.31], P = 1.63 × 10−6). All SNPs were associated with 2-h glucose (β = 0.06–0.12 mmol/allele, P ≤ 1.53 × 10−7), but no significant interactions were found with PA (P > 0.18) or BMI (P ≥ 0.04). In this large study of gene–lifestyle interaction, we observed no interactions between genetic and lifestyle factors, both of which were associated with 2-h glucose. It is perhaps unlikely that top loci from genome-wide association studies will exhibit strong subgroup-specific effects, and may not, therefore, make the best candidates for the study of interactions.

An Outpatient-Based Clinical Program For Diabetes Prevention: an Update

To update outcomes of the Diet-Exercise-Activity-Lifestyle (DEAL) program, a clinic-based diabetes prevention intervention. Changes in weight, fasting blood glucose, and 2-hour glucose after a 75-g oral glucose tolerance test were evaluated in patients who enrolled in the DEAL program between January 2007 and August 2009. The 221 qualified participants had a mean age of 62 years, weight of 87.4 kg, body mass index of 31.2 kg/m², fasting glucose level of 109 mg/dL, and 2-hour glucose value of 138 mg/dL. Among the program participants, 67% were women and 88% were white; 56% had isolated impaired fasting glucose, 5% had impaired glucose tolerance only, and 39% had both. The 6-month follow-up medical appointment was kept by 72% of program participants, but only 56% attended the 12-month visit. By 6 months after baseline, 59% had significantly lower fasting glucose concentrations, 59% had improvement in 2-hour glucose levels, and 61% had weight loss. Nearly 40%, however, were nonresponders and had increased fasting glucose, 2-hour glucose, and weight by 6 months. By the 12-month visit, significant declines in fasting glucose (P<.001), 2-hour glucose (P<.001), and weight (P = .008) occurred in comparison with baseline values; however, no significant changes occurred in these measures between the 6- and 12-month visits (P>.30 for all). Most DEAL participants showed improvement in glucose levels and weight, but some patients exhibited worsening glucose intolerance. Factors underlying nonresponse need to be identified. Ongoing experience and analysis should help revise the DEAL program so that outcomes for all participating patients will improve.

The “muffin test”—an alternative to the oral glucose tolerance test for detecting impaired glucose tolerance

The aim of this study was to compare the effectiveness of the "muffin test" (MT) with that of the oral glucose tolerance test (OGTT) in diagnosing impaired glucose tolerance (IGT). This is a cross-sectional study in a single academic institution. The participants were 73 women aged 42 to 58 years, less than 36 months after menopause, recruited for the Kronos Early Estrogen Prevention Study Trial. After a 10-hour fasting blood draw, the participants were provided a muffin and a beverage. Two-hour glucose levels were assessed. A subset underwent metabolic testing consisting of an OGTT (n = 12) and a mixed-meal tolerance test (n = 10). The main outcome measures were the prevalence of IGT and 2-hour glucose measurements after each testing method. Two-hour glucose levels were linearly related to fasting values by multivariable linear regression. This association was exaggerated in overweight (body mass index, 25 kg/m2) women (coefficient, 1.43; P < 0.001). Two-hour OGTT and MT glucose levels were comparable (P > 0.05); 2-hour glucose levels after OGTT were slightly lower than after the mixed-meal tolerance test (P < 0.05). The prevalence of IGT was 11% (8 of 73). Fasting plasma glucose alone would have missed 63% of cases (five of eight cases). The MT demonstrated 100% sensitivity and specificity for diagnosing IGT compared with the gold standard OGTT. This small pilot study should be confirmed in a larger prospective group of participants.

Association of Common Variants of CDKN2A/2B Rs10811661 (C/T)and WFS1 Rs6446482 (C/G) to Type 2 Diabetes Mellitus in the Indian Population of Eastern Uttar Pradesh

Aim: Recent genome-wide association studies (GWAS) have identified several unsuspected genes that significantly increase the risk of type 2 diabetes mellitus (T2DM). We aimed to replicate the association of a common variant each in CDKN2A/2B (rs10811661) and WFS1 (rs6446482) in the population of Eastern Uttar Pradesh, India. These variants have been identified to be differentially associated with T2DM in different ethnic groups in previous GWAS. Results: We found SNP rs10811661 of CDKN2A/2B (OR 1.50, 95% CI 1.109-2.032, P=0.009) and SNP rs6446482 of WFS1 (OR 1.43, 95% CI 1.074-1.896, P=0.014) as significant risk factors for T2DM in Eastern Uttar Pradesh population. Normal Glucose-Tolerant (NGT) subjects carrying risk allele of rs10811661 (C/T) and rs6446482 (C/G) polymorphisms had significantly higher Fasting Plasma Glucose (FPG) and 2-hour Postprandial Plasma Glucose (2h-PPPG) levels compared to non-carriers. Conclusion: Our study replicates the association of well established common variants of CDKN2A/2B rs10811661 (C/T) and WFS1 rs6446482 (C/G) with type 2 diabetes in the population of Eastern Uttar Pradesh, India. Interestingly, our data show larger effect size for both of the SNPs than those reported in European populations.

Dilemma in Diabetes Care Relates to Its Complications: Strategies for Prevention

The dilemma concerning the prevailing classification of Type 1 and Type 2 diabetes is a serious hindrance to effective diabetes care. Many patients who are classified with Type 2 diabetes have symptoms and require treatment similar to those classified with Type 1 diabetes. In addition, patients are often diagnosed with diabetes as a result of elevated fasting blood glucose instead of 2-hour postprandial glucose levels or oral glucose tolerance tests. The misdiagnosis of diabetes accompanied by prescription of oral hypoglycemic agents or antihypertensive therapy, have caused unwarranted health problems in people who may not have diabetes. In this article, patients are presented who illustrate the misdiagnosis of diabetes and the need of proper testing to uncover diabetes. Additional case histories indicate the effect that oral hypoglycemic agents and antihypertensive medications may have on patient health. Suggestions are made regarding proper diagnosis and care. In patients with established diabetes, adequate control of glycemia with insulin, diet restriction and weight reduction, fundamental to prevention of microvascular and macrovascular complications, is stressed. Hospitalizations are preventable if professionals spend time explaining details of diabetic care to patients thereby enabling them to take full responsibility of their illness. Glucose control with insulin therapy, concomitantly with means for weight reduction in obese individuals, must be discussed in a repetitive fashion with the patient. Uncontrolled diabetes, resulting in frequent hospitalizations for a variety of complications, has markedly escalated the cost of diabetic care. Patient education and cooperation are the cornerstone of successful diabetes therapy and the mainstay of prevention of diabetes complications. Thereby, the cost of diabetes care will be reduced. The classification of Type 1 and Type 2 diabetes conveys little to the patients about diabetes which is a potentially devastating disease, nevertheless, with full attention to glucose control, healthy living is attainable. Utmost care should be taken to identify if the person does or does not have diabetes by appropriate testing and attention to proper therapy.

Role of HbA1c in the Screening of Diabetes Mellitus in a Korean Rural Community

BackgroundRecently, the measurement of glycated hemoglobin (HbA1c) was recommended as an alternative to fasting plasma glucose or oral glucose tolerance tests for diagnosing diabetes mellitus (DM). In this study, we analyzed HbA1c levels for diabetes mellitus screening in a Korean rural population.MethodsWe analyzed data from 10,111 subjects from a Korean Rural Genomic Cohort study and generated a receiver operating characteristic curve to determine an appropriate HbA1c cutoff value for diabetes.ResultsThe mean age of the subjects was 56.3±8.1 years. Fasting plasma glucose and 2-hour plasma glucose after 75 g oral glucose tolerance tests were 97.5±25.6 and 138.3±67.1 mg/dL, respectively. The mean HbA1c level of the subjects was 5.7±0.9%. There were 8,809 non-DM patients (87.1%) and 1,302 DM patients (12.9%). A positive relationship between HbA1c and plasma glucose levels and between HbA1c and 2-hour plasma glucose levels after oral glucose tolerance tests was found in a scatter plot of the data. Using Youden's index, the proper cutoff level of HbA1c for diabetes mellitus screening was 5.95% (sensitivity, 77%; specificity, 89.4%).ConclusionOur results suggest that the optimal HbA1c level for DM screening is 5.95%.

Glycemic Profiles and Their Diagnostic Value among Inpatients in a Cardiology Clinic

Background: Most patients in cardiology clinics have diabetes mellitus (DM). Therefore, glucose monitoring is very important for these patients. Routinely, only fasting glucose is measured but not postprandial glucose and HbA1c; thus, the correlation between diabetes frequency and cardiac diagnosis in cardiology inpatients is unknown. The aim of this study was to determine the glucose abnormalities in inpatient cardiology clinics and their relationship with the diagnosis of heart disease. Material and method: 309 patients (107 F/202 M; mean age 63.4 ± 13 years) hospitalized in cardiology clinic between December 2009 and February 2010 was recruited to the study. Admission glucose level, body mass index (BMI), fasting glucose level after stabilization, 2-hour postprandial glucose levels, HbA1c and diagnosis were recorded for all subjects. Patients were evaluated as DM (+), DM (-), and new-onset DM. Cardiac diagnoses were classified as acute coronary syndrome (ACS) and others. Pre-diabetes was defined based on fasting/random glucose and HbA1c concentrations among the non-diabetic patients. Results: 108 (35%) of patients had DM, whereas 39 patients (12.6%) had unknown diabetes. Glucose profile of subjects with new-onset DM was similar to that of DM (+) patients. The remaining 162 patients (52.4%) were free of DM although 53 of them (32.7%) had prediabetes. Prediabetes was diagnosed in 17.1% of all patients. No difference was detected between ACS and Others regarding DM frequency. Admission/fasting glucose and HbA1c levels were found to be higher in ACS patients (p: 0.02). Prediabetic patients with ACS had higher admission and fasting glucose and also HbA1c levels than those with others.

Insulin secretion and insulin sensitivity on the oral glucose tolerance test (OGTT) in middle-aged Japanese

The aim of this study was to assess the changes in insulin secretion and insulin sensitivity in relation to fasting and 2-hour plasma glucose (PG) levels and to assess the independent contributions of their impairments to non-diabetic hyperglycemia. A total of 2157 Japanese workers (mean age 52.6±7.3 years and mean BMI 23.9±3.2 kg/m(2)) underwent an oral glucose tolerance test (OGTT). Of these subjects, 1125 had normal glucose tolerance (NGT), 525 subjects had isolated impaired fasting glucose (IFG), 159 subjects had isolated impaired glucose tolerance (IGT), 263 subjects had combined IFG and IGT, and 85 subjects had newly diagnosed type 2 diabetes. Insulinogenic index and Matsuda insulin sensitivity index (ISI) were significantly attenuated in subjects with normal but slightly elevated fasting PG, or in subjects with normal but slightly elevated 2-hour PG. Whereas, InsAUC(120)/GluAUC(120) was not significantly decreased in those subjects, and significant decrease of it was observed exclusively in subjects with abnormal fasting PG (≥ 106 mg/dL) or abnormal 2-hour PG (≥ 221 mg/dL). Using multiple regression analyses, both Matsuda ISI and insulinogenic index were independently correlated with PG concentrations in subjects with IFG and/or IGT, while Matsuda ISI alone was independently correlated with fasting PG concentrations in normoglycemic subjects. In conclusion, both insulinogenic index and Matsuda ISI were significantly attenuated in subjects with normal but slightly elevated PG. Lowering of Matsuda ISI was likely to be a strong contributor to 'elevation of fasting PG within the normal range' in this population.

Prevalence of Atherosclerosis-Related Risk Factors and Diseases in the Philippines

BackgroundWe conducted a survey in 2008 to measure the prevalence of lifestyle-related diseases and risk factors in Philippine adults.MethodsStratified multistage sampling was used to cover the entire Philippine population of adults aged 20 years or older. Using health questionnaires, anthropometric measurements, and blood examinations, the prevalences of atherosclerosis-related risk factors and diseases were determined. Survey results were compared with those obtained in 2003.ResultsOut of 7700 eligible subjects, 64% to 93.7% responded to different survey items. Age-adjusted hypertension prevalence was 24.6% at a single visit and 20.6% when corrected for true prevalence. The prevalence of diabetes was 3.9% on the basis of fasting blood glucose (FBG), 5.2% by FBG and history, and 6.0% when 2-hour post-load plasma glucose level was determined. The prevalence of dyslipidemia was 72.0% and the prevalence of smoking was 31%. The prevalence of obesity was 4.9% by body mass index (BMI), and 10.2% and 65.6% by waist-hip ratio (WHR) in men and women, respectively. The prevalences of coronary, cerebrovascular, and peripheral arterial diseases were 1.1%, 0.9%, and 1.0%, respectively.ConclusionsThe prevalences of risk factors for atherosclerosis were higher in 2008 than in 2003, although the increase in diabetes was not significant and smoking decreased. These findings indicate a need for active collaborative intervention by all government agencies and medical societies in the Philippines.

Development of coronary heart disease and ischemic stroke in relation to fasting and 2-hour plasma glucose levels in the normal range

BackgroundIndividuals who had normoglycemia but whose 2-hour plasma glucose (2hPG) concentrations did not return to the fasting plasma glucose (FPG) levels during an oral glucose tolerance test (OGTT) have been shown to have increased cardiovascular mortality. This is further investigated regarding to the first events of coronary heart disease (CHD) and ischemic stroke (IS).MethodData from 9 Finnish and Swedish cohorts comprising 3743 men and 3916 women aged 25 to 90 years who had FPG < 6.1 mmol/l and 2hPG < 7.8 mmol/l and free of CVD at enrolment were analyzed. Hazard ratios (HRs) for first CHD and IS events were estimated for the individuals with 2hPG > FPG (Group II) compared with those having 2hPG ≤ FPG (Group I).ResultsA total of 466 (115) CHD and 235 (106) IS events occurred in men (women) during a median follow-up of 16.4 years. Individuals in Group II were older and had greater body mass index, blood pressure, 2hPG and fasting insulin than those in Group I in both sexes. Multivariate adjusted HRs (95% confidence intervals) for incidence of CHD, IS, and composite CVD events (CHD + IS) in men were 1.13 (0.93-1.37), 1.40 (1.06-1.85) and 1.20 (1.01-1.42) in the Group II as compared with those in the Group I. The corresponding HRs in women were 1.33 (0.83-2.13), 0.94 (0.59-1.51) and 1.11 (0.79-1.54), respectively.ConclusionWithin normoglycemic range individuals whose 2hPG did not return to their FPG levels during an OGTT had increased risk of CHD and IS.

Insulin Sensitivity After Maximal and Endurance Resistance Training

The purpose of the study was to compare the effects of maximal resistance training (MRT) vs. endurance resistance training (ERT) on improvements in insulin levels and glucose tolerance in overweight individuals at risk of developing type 2 diabetes. Eighteen participants with baseline values suggesting impaired glucose tolerance were randomly assigned to 1 of 2 groups. Group 1 engaged in supervised MRT (Bernstein inverted pyramid system: 5 × 3-4, 60-85% 1 repetition maximum [1RM]), 3 d·wk(-1) over 4 months, whereas members of group 2 acted as controls. Later, group 2 engaged in supervised ERT (3 × 12-15, 45-65% 1RM), 3 d·wk(-1) over a 4 month period with the 2 prebaselines as controls. Both interventions consisted of 8 exercises that included the entire body. Glucose (fasting and 2-hour test), insulin and C-peptide measures were assessed from pre to post in both groups. The MRT led to reduced blood levels of 2-hour glucose (p = 0.044) and fasting C-peptide (p = 0.023) and decreased insulin resistance (p = 0.040). The ERT caused a significant reduction in the blood levels of insulin (p = 0.023) and concomitant positive effects on % insulin sensitivity (p = 0.054) and beta-cell function (p = 0.020). The findings indicate that both MRT and ERT lead to decreased insulin resistance in people with a risk of developing type 2 diabetes; MRT led to a greater increase in glucose uptake capacity (in muscles), whereas ERT led to greater insulin sensitivity, supporting the recommendation of both MRT and ERT as primary intervention approaches for individuals at a risk of developing type 2 diabetes.