2-hour Glucose Levels Research Articles

OR31-5 Characterization of the One-Hour Plasma Glucose and Plasma Insulin during an Oral Glucose Tolerance Test (OGTT) in Obese Hispanic Children and Adolescents Diagnosed with Prediabetes (Hba1c ≥ 5.7% & ≤ 6.4%)

Background: OGTT is still considered the gold standard test to detect prediabetes and /or Type 2 diabetes (T2D). American Diabetes Association criteria for prediabetes: a) Hba1c 5.7- 6.4% b) fasting plasma glucose (FPG) ≥ 100 mg/dl and/or post-prandial PG ≥ 140, Impaired glucose tolerance (IGT) during an OGTT. In adults the 1-hour(1hr) glucose level (≥ 155 mg/dl) is a strong predictor of future T2D risk than the two-hour level and is associated with diabetes complication. The ideal cut-off for pediatrics is not established though studies have found 1hPG ≥ 132.5 mg/dl, as predictive for risk of T2D (1) Objective: a. To study the dynamic profile of Plasma Glucose (PG) and plasma Insulin (PI) values at time 0,1 and 2 hour during an OGTT b. to assess whether degree of insulin resistance in Hispanic children and adolescents can be predict an abnormal I hr glucose level. Methods: We reviewed OGTT results of 43 obese Hispanic youths; 7-18 years of age with prediabetes. PG and PI values were obtained at 0, 1 and 2hr during OGTT (glucola: dose of 1.75 g/kg body weight up to a maximum of 75 g). The Homeostasis Model Assessment of fasting insulin resistance (HOMA-IR), an index of insulin resistance was calculated using (fasting glucose (mg/dl) X fasting insulin(µIU/ml)/405) and values ≥3.4 were taken as insulin resistance(2). Independent T test was used to study differences between means for group1: HOMA-IR< 3.4 and group 2: HOMA-IR≥ 3.4. Results: Forty-three obese Hispanic youths; 7-18 years of age; mean age of 11.5 ± 0.7; BMI=42.2 ± 4.9; 47% male and 53% female. a) OGTT results: Only one subject had abnormal fasting plasma glucose, 3 subjects had IGT (7%), and 11(26%) had an abnormal 1 h PG during the OGTT b) 1hr glucose and 1hr insulin was different between HOMA-IR groups (p=0.001) even though 2-hr was not. PG: grp#1: 1hr=108 ± 27, 2hr=107 ± 33 mg/dl; grp #2: 1hr=136 ± 33, 2hr=120 ± 32. PI: grp#1: 1hr= 80 ± 61, 2hr= 78 ± 70; grp#2: 1hr= 213 ±171, 2hr= 99 ± 375. Conclusion: In our Hispanic children and adolescents, 1& 2-hr plasma insulin and plasma glucose were clearly abnormal, more so, in the HOMA- IR group ≥ 3.4. This demonstrate that at least in the IR children and adolescents, 1-hour values add value to the interpretation of the OGTT. 26 % of Hispanic children and adolescents had an abnormal 1-hr glucose which is a novel finding of our study. These results validate the recent reports of the plasma 1-hr glucose threshold ≥132.5 mg/dl in Pediatrics and prospective follow up of these Hispanic patients will be able to demonstrate the predictive value of 1 hr values of insulin and glucose to development of T2D.Reference: ADDIN EN.REFLIST 1. Manco M, Miraglia Del Giudice E, et al. 1-Hour plasma glucose in obese youth. Acta diabetologica. 2012;49(6):435-43. 2. Brar PC, Screening obese children and adolescents for prediabetes and/or type 2 diabetes in pediatric practices: a validation study. Clinical pediatrics. 2014;53(8):771-6.

Effect of the GLP-1 Receptor Agonist Exenatide on Impaired Awareness of Hypoglycemia in Type 1 Diabetes: A Randomized Controlled Trial.

Impaired awareness of hypoglycemia (IAH), resulting from habituation to recurrent hypoglycemia, can be reversed by strict avoidance of hypoglycemia. Adjunctive treatment with glucagon-like peptide-1 receptor agonists may reduce glucose variability, hence lower the risk of hypoglycemia and improve awareness. The aim of our study was to investigate the effect of exenatide on awareness of hypoglycemia in patients with type 1 diabetes and IAH. This was a randomized double-blind, placebo-controlled crossover trial. Ten patients with type 1 diabetes and IAH were included [age, 38.5 ± 4.4 years; 40% males; glycated hemoglobin 7.2% ± 0.4% (55.2 ± 4.8 mmol/mol)]. Patients were treated with exenatide 5 µg twice daily (first two weeks), followed by 10 µg twice daily (remaining four weeks) or matching placebo, with a four-week washout period. Patients wore blinded glucose sensors in the final weeks and modified hyperinsulinemic normoglycemic-hypoglycemic glucose clamps (nadir 2.5 mmol/L) were performed at the end of each treatment period. Treatment with exenatide caused body weight to decrease compared with placebo (-3.9 ± 0.9 vs 0.6 ± 1.2 kg, P = 0.047). Exenatide did not change mean 24-hour glucose levels (8.3 ± 0.4 vs 8.5 ± 0.3 mmol/L, exenatide vs placebo, P = 0.64), median (interquartile range) percentage of time spent in hypoglycemia [15.5 (4.5, 25.5) vs 7.8 (4.4, 17.1)%, P = 0.11] and frequency of hypoglycemia (15.8 ± 3.7 vs 12.1 ± 3.5, P = 0.19). Symptom scores in response to clamped hypoglycemia were similar between exenatide [median change 1.0 (-1.5, 7.0)] and placebo [4.5 (1.5, 5.8), P = 0.08]. Six weeks of treatment with exenatide did not improve awareness of hypoglycemia in patients with type 1 diabetes and IAH.

Glucose Tolerance Levels and Circumpapillary Retinal Nerve Fiber Layer Thickness in a General Japanese Population: The Hisayama Study

To investigate the relationship between glucose tolerance levels and the circumpapillary retinal nerve fiber layer thickness (cpRNFLT) in a general Japanese population. Population-based, cross-sectional study. In 2012 and 2013, a total of 2809 Japanese community dwellers aged 40-79 years in the Hisayama Study underwent eye examinations including cpRNFLT measurement with spectral domain optical coherence tomography. Of these, 1324 subjects (578 men and 746 women) were enrolled. Glucose tolerance levels were determined by a 75-g oral glucose tolerance test. We conducted an analysis of covariance to estimate the mean values of cpRNFLT according to the subjects' glucose intolerance status. The subjects with prediabetes or with diabetes mellitus had significantly lower age- and sex-adjusted mean cpRNFLT values than those with normal glucose tolerance (P= .04 and P= .0004, respectively). The age- and sex-adjusted mean values of cpRNFLT decreased significantly with elevating fasting plasma glucose and 2-hour postload glucose levels (all P for trend < .05). These associations were substantially unchanged after adjustment for potential confounding factors. The coexistence of poorer glucose tolerance and higher intraocular pressure levels was additively associated with thinner cpRNFLT. Our analyses revealed that poorer glucose tolerance was significantly associated with the reduction of cpRNFLT in a Japanese general population, suggesting that the loss of neural tissue in the eye begins at the prediabetic stage, and that hyperglycemia may play a role in the reduction of cpRNFLT.

Factors influencing insulin sensitivity during hyperinsulinemic-euglycemic clamp in healthy Korean male subjects.

Background and objective: The effects of age and related factors on insulin sensitivity have not been definitively evaluated in East Asian populations. We proposed a reference range for the glucose disposal rate (M-value) on hyperinsulinemic-euglycemic study and its association with other parameters.Methods: Healthy, non-diabetic young (n=10) and elderly (n=13) male subjects with normal body mass index were eligible for this study. Subjects who passed the oral glucose tolerance test (OGTT) underwent hyperinsulinemic-euglycemic clamp with high-dose (80 mU/m2·min) insulin infusion.Results: M-values were normalized to body weight (MBW) and fat-free mass (MFFM). Neither M-value was significantly different between age groups (P=0.458 and P=0.900, respectively). An inverse correlation was observed between MFFM and baseline insulin (r=−0.418; P=0.047), baseline C-peptide (r=−0.426; P=0.043) and OGTT 2-hour glucose (r=−0.452; P=0.030). Regarding correlations with other insulin sensitivity indices, M-values were positively associated with the Matsuda index but not with homeostasis model assessment of insulin resistance.Conclusion: Our results suggest that age is not a critical determinant of insulin sensitivity, while fasting insulin and C-peptide levels, OGTT 2-hour glucose level, and Matsuda index are predictable markers of insulin sensitivity in healthy Koreans.

Perfluoroalkyl substances, metabolomic profiling, and alterations in glucose homeostasis among overweight and obese Hispanic children: A proof-of-concept analysis

ObjectiveTo examine the prospective associations between exposure to perfluoroalkyl substances (PFASs) and longitudinal measurements of glucose metabolism in high-risk overweight and obese Hispanic children. MethodsForty overweight and obese Hispanic children (8–14 years) from urban Los Angeles underwent clinical measures and 2-hour oral glucose tolerance tests (OGTT) at baseline and a follow-up visit (range: 1–3 years after enrollment). Baseline plasma perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonic acid (PFHxS), and the plasma metabolome were measured by liquid-chromatography with high-resolution mass spectrometry. Multiple linear regression models were used to assess the association between baseline PFASs and changes in glucose homeostasis over follow-up. A metabolome-wide association study coupled with pathway enrichment analysis was performed to evaluate metabolic dysregulation associated with plasma PFASs concentrations. We performed a structural integrated analysis aiming to characterize the joint impact of all factors and to identify latent clusters of children with alterations in glucose homeostasis, based on their exposure and metabolomics profile. ResultsEach ln (ng/ml) increase in PFOA and PFHxS concentrations was associated with a 30.6 mg/dL (95% CI: 8.8–52.4) and 10.2 mg/dL (95% CI: 2.7–17.7) increase in 2-hour glucose levels, respectively. A ln (ng/ml) increase in PFHxS concentrations was also associated with 17.8 mg/dL increase in the glucose area under the curve (95% CI: 1.5–34.1). Pathway enrichment analysis showed significant alterations of lipids (e.g., glycosphingolipids, linoleic acid, and de novo lipogenesis), and amino acids (e.g., aspartate and asparagine, tyrosine, arginine and proline) in association to PFASs exposure. The integrated analysis identified a cluster of children with increased 2-h glucose levels over follow up, characterized by increased PFAS levels and altered metabolite patterns. ConclusionsThis proof-of-concept analysis shows that higher PFAS exposure was associated with dysregulation of several lipid and amino acid pathways and longitudinal alterations in glucose homeostasis in Hispanic youth. Larger studies are needed to confirm these findings and fully elucidate the underlying biological mechanisms.

Association of polymorphisms in STRA6 gene with gestational diabetes mellitus in a Chinese Han population.

Cell and animal experiments have found that in addition to being a retinol transporter, Stimulated by Retinoic Acid 6 (STRA6) also functions as a surface signaling receptor by which retinol regulates insulin responses. Several studies revealed that the STRA6 gene may contribute to the pathogenesis of type 2 diabetes mellitus (T2DM). Gestational diabetes mellitus (GDM) and T2DM have some risk factors in common. The present study was directed to investigate whether the 3 single nucleotide polymorphism (SNPs) (rs11633768, rs351219, and rs736118) of STRA6 correlate with the development of GDM in Chinese pregnant women. We also aimed to estimate the relationship between SNPs with fasting blood glucose level, 1-hour and 2-hour blood glucose levels after 75 g oral glucose intake, fasting insulin and insulin resistance levels to better study the relationship between STRA6 and glucose metabolism.Case–control studies were conducted to compare the GDM and control groups. A total of 334 cases and 367 controls were recruited. Three tagSNPs of STRA6, rs11633768, rs351219, and rs736118, were selected. A chi-square test, logistic regression, and linear regression were used to estimate the relationship between SNPs with GDM risk and oral glucose tolerance test (OGTT), fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) levels. Regression analyses were all adjusted by maternal age, pre-pregnancy BMI, and weekly BMI growth. The Bonferroni correction was applied for multiple comparisons.After adjusting the maternal age, pre-pregnancy BMI and weekly BMI growth, STRA6 rs736118 was associated with fasting insulin level (Beta = −1.468, P = .036), and the association between rs736118 and HOMA-IR was of borderline significance (Beta = −0.290, P = .093) under the dominance model.This study found that there is a significant association between STRA6 polymorphism and GDM.

New-Onset Post-Transplant Diabetes Mellitus after Allogeneic Hematopoietic Cell Transplant Is Initiated by Insulin Resistance, Not Immunosuppressive Medications.

New-onset post-transplant diabetes mellitus (PTDM) occurs frequently after allogeneic hematopoietic cell transplant (HCT). Although calcineurin inhibitors and corticosteroids are assumed to be the cause for hyperglycemia, patients developing PTDM have elevated fasting C-peptide levels before HCT and before immunosuppressive medications. To determine if PTDM results from established insulin resistance present before transplant, we performed oral glucose tolerance tests (OGTTs) and measured whole body, peripheral, and hepatic insulin sensitivity with euglycemic hyperinsulinemic clamps before and 90 days after HLA-identical sibling donor HCT in 20 patients without pretransplant diabetes. HCT recipients were prospectively followed for the development of new-onset PTDM defined as a weekly fasting blood glucose ≥ 126 mg/dL or random blood glucose ≥ 200 mg/dL. During the first 100 days all patients received calcineurin inhibitors, and 11 individuals (55%) were prospectively diagnosed with new-onset PTDM. PTDM diagnosis preceded corticosteroid treatment. During the pretransplant OGTT, elevated fasting (87 mg/dL versus 101 mg/dL; P = .005) but not 2-hour postprandial glucose levels predicted PTDM diagnosis (P = .648). In response to insulin infusion during the euglycemic hyperinsulinemic clamp, patients developing PTDM had lower whole body glucose utilization (P = .047) and decreased peripheral/skeletal muscle uptake (P = .031) before and after transplant, respectively, when compared with non-PTDM patients. Hepatic insulin sensitivity did not differ. Survival was decreased in PTDM patients (2-year estimate, 55% versus 100%; P = .039). Insulin resistance before HCT is a risk factor for PTDM independent of immunosuppression. Fasting pretransplant glucose levels identified PTDM susceptibility, and peripheral insulin resistance could be targeted for prevention and treatment of PTDM after HCT.

Pregnancy outcomes of early detected gestational diabetes: a retrospective comparison cohort study, Qatar

ObjectiveTo compare pregnancy outcomes in patients with early versus usual gestational diabetes mellitus (GDM).DesignA retrospective cohort study.SettingsThe Women’s Hospital, Hamad Medical Corporation, Qatar.ParticipantsGDM women who attended and delivered in the...

Effect of vitamin D deficiency on the 75 g oral glucose tolerance test screening and insulin resistance

Gestational diabetes mellitus (GDM), is the most common medical complications of pregnancy. This study aimed to clarify the effect of second-trimester vitamin D deficiency on the 75 g oral glucose tolerance test (OGTT) screening and insulin resistance. A total of 120 pregnant women with a singleton pregnancy at a gestational age of 26–28 weeks were analyzed. Participants were divided into two groups according to 25-hydroxyvitamin D levels; vitamin D deficiency, and control groups. For GDM scan, 75 g OGTT was preferred. GDM prevalence was 17.5% in vitamin D deficiency group and 13.75% in control group, there is no significant difference in GDM prevalence (p = 0.149). Fasting plasma glucose and 1-h plasma glucose levels were significantly higher in the vitamin D deficiency group than in the control group (p < .001 and p < .001, respectively). No significant differences were observed between 2-hour plasma glucose levels (p = .266). The HOMA-IR level was significantly higher in the vitamin D deficiency group than in the control group (p < .001). The findings of the present study suggested that vitamin D deficiency in the second trimester was inversely correlated with fasting and 1-h plasma glucose after 75 g glucose challenge test; also, low 25 OHD3 levels were associated with insulin resistance.

Comparison of Blood Glucose Levels in Type 2 Diabetic Patients Who Consume Rice Steamed and Through the Magicom Method

Differences in cooking techniques can affect the glycemic level of rice. The aim of this study was to identify the differences in the blood glucose levels of people with DM after consuming rice cooked using either the steamed method or magicom. This study used a pre-experimental design with one group pre-post test with a repeated measure, which was then compared with the difference in fasting glucose levels with a 2-hour post prandial glucose level. The sample consisted of 24 type 2 DM patients. The independent variable was the cooking method and the dependent variable was the blood glucose level. The data collection was conducted using an observation and a questionnaire. The data analysis was done using a paired t test with a significance level of 0.05. The results of the independent sample t-test analysis obtained a value of t = -1.583 and p = 0.128, so there was found to be no significant difference between the fasting blood glucose levels and 2 hours post-prandial. The results of the descriptive comparison analysis showed that there were differences in the glucose levels between consuming rice cooked using either the steamed or magicom method of 18.304 gr / dl with p = 0.128. Rice cooked with the steamed method is more likely not to increase the blood glucose levels than rice cooked with mMagicom. DM patients should consume rice that has not been heated for a long time. Keywords: Blood Glucose Level, Steam Method, mMagicom, Diabetes Mellitus Tipe 2

Comparative Study between Metformin and Insulin in Controlling Gestational Diabetes Mellitus

Background: the use of antidiabetic drugs to control gestational diabetes was controversial. Some studies suggest a possible link between the use of oral antidiadetics and fetal anomalies, fetal macrosomia and neonatal hypoglycemia whereas others have demonstrated no such relationship. Objective: This study aims to assess the efficacy of metformin in controlling maternal blood glucose level compared to insulin in women with GDM. Patients and Methods: The present study included 116 pregnant women who have been diagnosed as gestational diabetics before 34 weeks gestation with singleton pregnancy. They had FBG level ranging from 90- 169 mg/ dl or 2-hour postprandial blood glucose level ranging from 110-176 mg/dl. The exclusion criteria include pregnant women with preexisting DM and underlying diseases known to affect fetal growth, preeclampsia, unbalanced chronic disease, twin pregnancy, or refused to participate. Results: Comparison of the baseline characteristics was performed between 2 groups and there were no significant differences between the two groups regarding maternal age, gravidity, parity, GA at time of diagnosis, GA at beginning of treatment, and BMI at time of diagnosis. Analysis of the results revealed that metformin was an effective medication for control of euglycemic with diet only.

Comparative Study between Metformin and Insulin in Controlling Gestational Diabetes Mellitus

Background: the use of antidiabetic drugs to control gestational diabetes was controversial. Some studies suggest a possible link between the use of oral antidiadetics and fetal anomalies, fetal macrosomia and neonatal hypoglycemia whereas others have demonstrated no such relationship. Objective: This study aims to assess the efficacy of metformin in controlling maternal blood glucose level compared to insulin in women with GDM. Patients and Methods: The present study included 116 pregnant women who have been diagnosed as gestational diabetics before 34 weeks gestation with singleton pregnancy. They had FBG level ranging from 90- 169 mg/ dl or 2-hour postprandial blood glucose level ranging from 110-176 mg/dl. The exclusion criteria include pregnant women with preexisting DM and underlying diseases known to affect fetal growth, preeclampsia, unbalanced chronic disease, twin pregnancy, or refused to participate. Results: Comparison of the baseline characteristics was performed between 2 groups and there were no significant differences between the two groups regarding maternal age, gravidity, parity, GA at time of diagnosis, GA at beginning of treatment, and BMI at time of diagnosis. Analysis of the results revealed that metformin was an effective medication for control of euglycemic with diet only.

Is it necessary to screen patient with adhesive capsulitis of shoulder for diabetes mellitus?

Background:Idiopathic adhesive capsulitis of shoulder is common cause of pain and restriction of shoulder motion between the ages of 30 and 65. The prevalence of adhesive capsulitis is as high as 10% to 22% in diabetes mellitus as compared normal population which is 02% and 04%. Therefore, the doubt arises whether patients developed adhesive capsulitis are at greater risk to develop diabetes mellitus and should be screen for diabetes so that it can be detected early.Purpose:To compare the prevalence of prediabeties and diabetes mellitus among patients with features of idiopathic adhesive capsulitis of shoulder who are otherwise healthy.Methods:Patients between 30-65 years of age who attended Orthopaedics OPD with features of idiopathic adhesive capsulitis of shoulder were included. Participated underwent a 2 hour long oral glucose tolerance test and based on fasting and 2-hour plasma glucose levels, patients were diagnosed as normal glucose tolerance, prediabetic, or diabetic and the results were matched with previous published data.Results:135 patients as participated and completed the test. 21 (15.5%) patients with idiopathic adhesive capsulitis of shoulder were found to be prediabetic, and 37 (27.4%) patients were found to be diabetic. However, 31 patients had family history of diabetes.Conclusion:Based on our study, we can recommend that patients with features of idiopathic adhesive capsulitis of shoulder should be screened at least for fasting and post prandial blood sugar so that diabetes can be detected early.

Macrosomic Newborn and Glucose Level in Lean Pregnant Diabetes Mellitus Patients at Dr. Soetomo General Hospital Surabaya

Background : Gestational diabetes mellitus, defined as glucose intolerance in variable degree with onset during pregnancy, is a risk factor for the development of fetal macrosomia, a newborn with the birthweight of more than 4000g. The objective of this study was to explore an association between glucose level in lean pregnant diabetes mellitus patients, resulting in babies and the incidence of macrosomia in Dr Soetomo General Hospital in Surabaya. Methods : This was a retroprospective analytic study with a cross sectional design by using medical records at Dr. Soetomo General Hospital Surabaya, collected from January 2016 to December 2017. The correlation between fasting glucose level, 2-hour postprandial glucose and glucose level at the time of birth and weight of newborn was assessed. Results : Controlled and uncontrolled fasting glucose level, 2-hour postprandial glucose level and glucose level at the time of birth of mother were not significantly associated with macrosomia newborns. Macrosomia newborn were born with gestational diabetes mellitus mothers compare with pregestational mellitus mothers. Conclusions : There is no association between macrosomia with glucose level of lean gestational and pregestational diabetes mellitus, however, therapeutic approach such as physical exercise should be implemented to reduce effects of uncontrolled glucose level.

PRISMA-efficacy and safety of lixisenatide for type 2 diabetes mellitus: A meta-analysis of randomized controlled trials.

We aimed to systematically evaluate the efficacy and safety of lixisenatide in patients with type 2 diabetes mellitus. PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, Google, Web of Science and the Chinese Science Citation Database were searched up to March 2018. Randomized controlled trials determining the efficacy and safety of lixisenatide in patients with type 2 diabetes mellitus were eligible for inclusion. Two authors independently extracted the data in a prespecified Microsoft Excel spreadsheet. A meta-analysis was performed using Review Manager 5.3 software. Weighted mean difference (WMD) and relative risk (RR) together with their corresponding 95% confidence intervals (CIs) were estimated, and only the random effects model was used in order to achieve a more conservative estimate of the efficacy and safety. Fourteen multicenter randomized controlled trials involving 11,947 patients were eligible for inclusion. Compared to placebo, lixisenatide could more significantly reduce the level of HbA1c (WMD=-0.44; 95% confidence interval [CI] [-0.55,-0.33]), and a higher proportion of lixisenatide-treated patients achieved the HbA1c level of < 7.0% (RR = 1.89, 95% CI [1.75-2.03]) and < 6.5% (RR = 3.03, 95% CI [2.54-3.63]) than the placebo-treated patients. Lixisenatide was also associated with a significant reduction in fasting plasma glucose and 2-hour postprandial plasma glucose levels. The risks for any adverse events, gastrointestinal adverse events, and symptomatic hypoglycemia significantly increased in the lixisenatide-treatedment group compared to those in the placebo group. However, lixisenatideit did not increase the risks of serious adverse events, death, or severe hypoglycemia. Lixisenatide was more effective than placebo in patients with type 2 diabetes mellitus, and the mild-to-moderate adverse events were found to be tolerated during the follow-up.

Prediction of Glucose Metabolism Disorder Risk Using a Machine Learning Algorithm: Pilot Study.

BackgroundA 75-g oral glucose tolerance test (OGTT) provides important information about glucose metabolism, although the test is expensive and invasive. Complete OGTT information, such as 1-hour and 2-hour postloading plasma glucose and immunoreactive insulin levels, may be useful for predicting the future risk of diabetes or glucose metabolism disorders (GMD), which includes both diabetes and prediabetes.ObjectiveWe trained several classification models for predicting the risk of developing diabetes or GMD using data from thousands of OGTTs and a machine learning technique (XGBoost). The receiver operating characteristic (ROC) curves and their area under the curve (AUC) values for the trained classification models are reported, along with the sensitivity and specificity determined by the cutoff values of the Youden index. We compared the performance of the machine learning techniques with logistic regressions (LR), which are traditionally used in medical research studies.MethodsData were collected from subjects who underwent multiple OGTTs during comprehensive check-up medical examinations conducted at a single facility in Tokyo, Japan, from May 2006 to April 2017. For each examination, a subject was diagnosed with diabetes or prediabetes according to the American Diabetes Association guidelines. Given the data, 2 studies were conducted: predicting the risk of developing diabetes (study 1) or GMD (study 2). For each study, to apply supervised machine learning methods, the required label data was prepared. If a subject was diagnosed with diabetes or GMD at least once during the period, then that subject’s data obtained in previous trials were classified into the risk group (y=1). After data processing, 13,581 and 6760 OGTTs were analyzed for study 1 and study 2, respectively. For each study, a randomly chosen subset representing 80% of the data was used for training 9 classification models and the remaining 20% was used for evaluating the models. Three classification models, A to C, used XGBoost with various input variables, some including OGTT data. The other 6 classification models, D to I, used LR for comparison.ResultsFor study 1, the AUC values ranged from 0.78 to 0.93. For study 2, the AUC values ranged from 0.63 to 0.78. The machine learning approach using XGBoost showed better performance compared with traditional LR methods. The AUC values increased when the full OGTT variables were included. In our analysis using a particular setting of input variables, XGBoost showed that the OGTT variables were more important than fasting plasma glucose or glycated hemoglobin.ConclusionsA machine learning approach, XGBoost, showed better prediction accuracy compared with LR, suggesting that advanced machine learning methods are useful for detecting the early signs of diabetes or GMD. The prediction accuracy increased when all OGTT variables were added. This indicates that complete OGTT information is important for predicting the future risk of diabetes and GMD accurately.

Management of postprandial hyperglycaemia and weight gain in women with gestational diabetes mellitus using a novel telemonitoring system.

ObjectivesThe purpose of this study was to investigate the effect of remotely delivered telemedicine dietary advice on monitoring of blood glucose levels and weight gain of women with gestational diabetes mellitus (GDM).MethodsWomen with GDM were recruited and randomly allocated into two groups: a Tele-GDM group that received a telemonitoring device, and a control group that was followed-up traditionally. A telemonitoring service calculated the ratio of reaching or exceeding the pregnancy weight gain target (according to pre-pregnancy weight), following Institute of Medicine guidelines for healthy pregnancy weight gain.ResultsThe sample comprised 27 women in the Tele-GDM group and 30 in the control group. At the end of pregnancy, the Tele-GDM group showed significantly lower 2-hour postprandial glucose levels than the control group. Most women in the Tele-GDM group reached their recommended range of weight gain at the end of pregnancy. Additionally, the Tele-GDM group showed significantly lower weight gain than the control group.ConclusionsTelemonitoring can facilitate close monitoring of women with GDM and motivate patients to adopt a healthy lifestyle.

Genetic variation in TCF7L2 rs7903146 and history of GDM negatively and independently impact on diabetes-associated metabolic traits

AimsGestational diabetes (GDM) is recognized as a major risk factor for the development of type 2 diabetes (T2DM) later in life. Risk allele carriers at TCF7L2 rs7903146 have increased susceptibility for both GDM and T2DM. We hypothesized that carrying TCF7L2 risk alleles would further aggravate the negative impact of a positive history for GDM on metabolic traits related to T2DM later in life. Methods210 women with a confirmed history of gestational diabetes and 810 controls without evidence for GDM underwent standardized 75 g oral glucose tolerance tests (OGTT). Liver fat was quantified in a subset of subjects (n = 444) using magnetic resonance spectroscopy. Results504 women were homozygous or heterozygous risk allele carriers. The risk allele carriers had a higher risk for GDM (p = 0.0076, OR 1.52, 95% CI 1.11–2.06). Multivariable regression analysis demonstrated that both a history of GDM, or carrying a TCF7L2 risk allele resulted in lower insulin secretion, impaired proinsulin processing and higher fasting and 2-hour glucose levels. Liver fat content was not associated with either a history of GDM or a TCF7L2 risk genotype. There was no significant interaction (all p > 0.05) between history of GDM and TCF7L2 risk alleles on all diabetes-associated metabolic traits tested. ConclusionThe TCF7L2 rs7903146 polymorphism is a risk factor for gestational diabetes. However, the additional presence of TCF7L2 rs7903146 risk alleles does not further aggravate the negative impact of a history of gestational diabetes on metabolic traits related to T2DM.

Comparison of HbA1c and OGTT for the diagnosis of type 2 diabetes in children at risk of diabetes

The aim of this study was to evaluate the correlation between plasma glucose and HbA1c and the diagnostic accuracy of HbA1c as a screening tool to identify asymptomatic diabetes mellitus in children and adolescents with obesity or asymptomatic glucosuria. A total of 190 subjects who underwent an oral glucose tolerance test (OGTT) to confirm diabetes were categorized into normal glucose tolerance (NGT; n=117), impaired glucose tolerance (IGT; n=33), and diabetes (DM; n=40) according to the OGTT. Forty-seven patients with DM were diagnosed by either OGTT or HbA1c levels. The diagnostic accuracy for the detection of diabetes is based on 47 patients. Laboratory tests were performed after 12h of fasting. According to the HbA1c criterion, 107 (55.3%) subjects were in the NGT group, 41 (21.6%) were in the IGT group, and 42 (22.1%) were in the DM group. Diagnostic sensitivities of HbA1c and 2-hour plasma glucose level following OGTT (2-h OGTT) for DM were significantly higher than that of fasting plasma glucose, FPG (89.4, 85.1 vs. 63.8%). In addition, the area under the curves of diagnostic criteria was 0.970 for HbA1c, 0.939 for FPG and 0.977 for 2-h OGTT. Mean FPG and 2-h OGTT for HbA1c level >6.5% were 115.2mg/dL and 181.8mg/dL, respectively. The optimal HbA1c level cut-off point for predicting DM is 6.15%, with a sensitivity of 95.7% in Korean children and adolescents. The HbA1c criterion ≥6.5% was adequate to detect DM among Korean children and adolescents with obesity or asymptomatic glucosuria. We also recommend HbA1c level of 6.15% as the optimal cut-off point for detecting DM in Korean children and adolescents.

Prevention of type 2 diabetes mellitus with acupuncture: Protocol for a systematic review and meta-analysis.

Prediabetes is prevalent and significantly increases lifetime risk of progression to type 2 diabetes mellitus (T2DM). Acupuncture has been increasingly used for prediabetes in China but its effect is unclear. We aim to assess the efficacy and safety of acupuncture in preventing or delaying incident diabetes among individuals with prediabetes. The following 8 databases will be searched from inception to September 1, 2018: the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, PubMed, Embase, Chinese National Knowledge Infrastructure database, Chinese Biomedical Literature database, Chinese Scientific Journal database, Wan Fang database, and Clinical Trials. The incidence of diabetes and regression toward normoglycemia will be accepted as the primary outcomes. The Cochrane Risk of Bias tool will be used to evaluate the methodologic quality of eligible studies. Meta-analysis will be performed by Review Manager 5.3. This study will provide a high-quality synthesis of current evidence of acupuncture in the prevention of T2DM from several aspects including the incidence of diabetes, regression toward normoglycemia, fasting plasma glucose, 2-hour plasma glucose level after a 75-g oral glucose tolerance test, glycosylated hemoglobin level, body mass index, and adverse drug events. The conclusion of this review will provide evidence to judge whether acupuncture is an effective and safe intervention for prediabetes. PROSPERO CRD42018111236.