2-hour Postload Glucose Levels Research Articles

Metabolic Syndrome and C-reactive Protein are Associated With a Reduced Myocardial Mechano-energetic Efficiency.

Metabolic syndrome and elevated high-sensitivity C-reactive protein (hsCRP) levels are associated with risk of cardiovascular diseases. A reduced myocardial mechano-energetic efficiency (MEE) has been found to be an independent predictor of cardiovascular disease. To evaluate the association between metabolic syndrome and hsCRP levels with impaired MEE. Myocardial MEE was assessed by a validated echocardiography-derived measure in 1975 nondiabetic and prediabetic individuals subdivided into 2 groups according to the presence of metabolic syndrome. Individuals with metabolic syndrome exhibited increased stroke work and myocardial oxygen consumption estimated by rate pressure product, and a reduced MEE per gram of left ventricular mass (MEEi) compared with subjects without metabolic syndrome, after adjusting for age and sex. Myocardial MEEi progressively decreased in parallel with the increase in the number of metabolic syndrome components. In a multivariable regression analysis, both metabolic syndrome and hsCRP contributed to reduced myocardial MEEi independently of sex, total cholesterol, high-density lipoprotein, triglycerides, fasting, and 2-hour postload glucose levels. When the study population was divided into 4 groups by the presence or absence of metabolic syndrome and by hsCRP levels above and below 3 mg/L, hsCRP levels ≥3 mg/L were associated with reduced myocardial MEEi both in subjects with metabolic syndrome and in those without the syndrome. Nondiabetic and prediabetic individuals with metabolic syndrome exhibit increased stroke work and myocardial oxygen consumption, and an impaired MEEi, an established predictor of adverse cardiovascular events, and elevated hsCRP levels in combination with metabolic syndrome aggravate the myocardial MEEi impairment.

Biological and sociocultural determinants of increased blood pressure among women with a history of gestational diabetes mellitus in rural China: a retrospective cohort study

ObjectivesGestational diabetes mellitus (GDM) increases the risk of hypertension and cardiovascular events among mothers later in life. This risk has not been well recognised by healthcare professionals in rural China....

Predictive capability of fasting-state glucose and insulin measurements for abnormal glucose tolerance in women with polycystic ovary syndrome.

ObjectiveThe aim of the present study was to evaluate the predictive capability of fasting-state measurements of glucose and insulin levels alone for abnormal glucose tolerance in women with polycystic ovary syndrome (PCOS).MethodsIn total, 153 Korean women with PCOS were included in this study. The correlations between the 2-hour postload glucose (2-hr PG) level during the 75-g oral glucose tolerance test (OGTT) and other parameters were evaluated using Pearson correlation coefficients and linear regression analysis. The predictive accuracy of fasting glucose and insulin levels and other fasting-state indices for assessing insulin sensitivity derived from glucose and insulin levels for abnormal glucose tolerance was evaluated using receiver operating characteristic (ROC) curve analysis.ResultsSignificant correlations were observed between the 2-hr PG level and most fasting-state parameters in women with PCOS. However, the area under the ROC curve values for each fasting-state parameter for predicting abnormal glucose tolerance were all between 0.5 and 0.7 in the study participants, which falls into the “less accurate” category for prediction.ConclusionFasting-state measurements of glucose and insulin alone are not enough to predict abnormal glucose tolerance in women with PCOS. A standard OGTT is needed to screen for impaired glucose tolerance and type 2 diabetes mellitus in women with PCOS.

30-minute postload plasma glucose levels during an oral glucose tolerance test predict the risk of future type 2 diabetes: the Hisayama Study

IntroductionTo investigate the associations of 30 min postload plasma glucose (30 mPG) levels during an oral glucose tolerance test (OGTT) with the risk of future diabetes in a general Japanese...

From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management.

Aims Despite the very clear association between polycystic ovary syndrome (PCOS) and dysglycemia, few studies have explored the continuum of glycemic alterations leading from minor glucose abnormalities to overt diabetes. The purpose of this review is to trace the natural history of glycemic alteration in women with PCOS. Methods We performed a literature review without time limit until August 2019. Inclusion criteria were studies addressing the association between impaired glucose tolerance or impaired fasting glucose or type 2 diabetes (T2D) and PCOS with at least an English abstract. The exclusion criteria were no PCOS or impaired glucose tolerance or impaired fasting glucose or T2D as outcome. The outcomes of interest were the onset of impaired glucose tolerance, impaired fasting glucose, T2D, and the progression from impaired glucose tolerance or impaired fasting glucose to T2D. Results Healthy diet and physical activity are the first-line therapy for PCOS. Treatment with metformin was associated with significant lower 2-hour postload glucose levels and with reduction in fasting glucose when compared to placebo. Thiazolidinediones were more effective in reducing fasting glucose levels compared to placebo. Metformin and pioglitazone treatments showed similar effects on fasting glucose levels. The sodium-glucose cotransporter-2 inhibitor empagliflozin did not show differences in metabolic parameters when compared to metformin. The combination therapy with metformin plus the glucagon-like peptide-1 receptor agonist liraglutide was associated with significant improvements in basal and postload glucose levels compared with only liraglutide. Likewise, a combination therapy with the dipeptidyl peptidase-4 inhibitor saxagliptin and metformin demonstrated superiority versus metformin in fasting glucose and oral glucose tolerance test normalization. Myo-inositol supplementation was associated with lower insulin levels, glucose levels, and insulin resistance when compared with placebo, metformin, or estrogen treatments. Conclusions The use of insulin-sensitizing agents, such as metformin and inositols, along with lifestyle interventions may improve the metabolic profile in PCOS women.

Prediction of Persistent Impaired Glucose Tolerance in Patients with Minor Ischemic Stroke or Transient Ischemic Attack

Background: Impaired glucose tolerance (IGT) in patients with ischemic stroke can return to normal, reflecting an acute stress response, or persist. Persistent IGT is associated with an increased risk of recurrent stroke, other cardiovascular diseases and unfavorable outcome after stroke. We aim to validate our previously developed model to identify patients at risk of persistent IGT in an independent data set, and, if necessary, update the model. Methods: The validation data set consisted of 239 nondiabetic patients with a minor ischemic stroke or TIA and IGT in the acute phase (2-hour post-load glucose levels between 7.8 and 11.0 mmol/l). The outcome was persistent versus normalized IGT, based on repeated oral glucose tolerance test after a median of 46 days. The discriminative ability of the original model was assessed with the area under the ROC curve (AUC). The updated model was internally validated with bootstrap resampling and cross-validated in the development population of the original model. Results: One-hundred eighteen of 239 (49%) patients had persistent IGT. The original model, with the predictors age, current smoking, statin use, triglyceride, hypertension, history of cardiovascular diseases, body mass index (BMI), fasting plasma glucose performed poorly (AUC .60). The newly developed model included only BMI, hypertension, statin use, atrial fibrillation, 2-hour post-load glucose levels, HbA1c, large artery atherosclerosis, and predicted persistent IGT more accurately (internally validated AUC 0.66, externally validated AUC .71). Conclusions: This prediction model with simple clinical variables can be used to predict persistent IGT in patients with IGT directly after minor stroke or TIA, and may be useful to optimize secondary prevention by early identification of patients with disturbed glucose metabolism.

73-LB: Improvements in Sleep Quality after Cognitive Behavioral Therapy for Insomnia Are Associated with Improved 2-Hour Post-Load Glucose

Poor-quality sleep may be a possible modifiable risk factor in the development of T2DM. We conducted a pilot clinical trial (N=17) to examine the effects of insomnia treatment on insulin resistance in persons with prediabetes. Participants received up to 7 sessions of cognitive behavioral therapy for insomnia (CBT-I), a highly effective, first-line treatment for insomnia. Before and after CBT-I, participants underwent 75-gram oral glucose load test and wore wrist Actiwatches (ActiGraph GT9X Link) to measure sleep indices. Actigraphy data were collected, including wake after sleep onset (WASO; length of periods of wakefulness after sleep onset) and sleep efficiency (SE; ratio of time asleep to time in bed). We calculated the correlation between change in 2-hour post-load glucose and change in WASO and SE in those who completed treatment (at least 6 sessions of CBT-I; N=13). Decreases in WASO and increases in SE after CBT-I (indicating improved sleep) were associated with decreased 2-hour post load glucose levels (see Figure). The estimated Pearson correlations indicated medium-large effect sizes per Cohen’s rule, suggesting a potential reduction in the risk of full T2DM. This small pilot study shows the need for further research on whether treatment of insomnia improves glucose tolerance. Disclosure E.S. LeBlanc: None. N. Smith: None. M. Allison: None. G. Clarke: None. Funding Kaiser Permanente

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.

1-Hour and 2-Hour Postload Glucose Level on Oral Glucose Tolerance Test and the Risk of Incident Metabolic Syndrome.

Metabolic syndrome (MetS) increases the cardiometabolic risk even in nondiabetic patients. Previous studies have demonstrated that 1-hour postload glucose (PG) and 2-hour PG based on oral glucose tolerance test (OGTT) predicted cardiometabolic risk. However, it is still unclear whether and to what extent postload glucose is associated with the risk of MetS. A total of 5389 nondiabetic Koreans were dichotomized into normoglycemic (NG) groups and abnormal glycemic groups based on OGTT, including elevated 1-hour PG (155 to 199 mg/dL) and impaired glucose tolerance (IGT) (2-hour PG 140 to 199 mg/dL), and followed up for 10 years. Cox proportional hazard model was used to evaluate hazard ratios (HRs) with 95% CIs for incident MetS. Subgroups were determined by high or normal 1-hour PG (cutoff: 155 mg/dL) and 2-hour PG (cutoff: 140 mg/dL). Compared with NG, the risk of MetS increased proportionally to the level of 1-hour PG and 2-hour PG, independently of the number of baseline metabolic components. Even within people with normoglycemia, elevated PG above specific levels (1-hour PG ≥115 mg/dL and 2-hour PG ≥100 mg/dL) was significantly associated with the increased risk of MetS. In subgroup analysis, adjusted HR for MetS was higher in the group with high 1-hour PG and normal 2-hour PG [1.53 (95% CI, 1.35 to 1.74)] than in the group with normal 1-hour PG and high 2-hour PG [1.32 (95% CI, 1.02 to 1.70)]. Elevated 1-hour PG and 2-hour PG significantly are associated with greater risk for MetS, and 1-hour PG was superior to 2-hour PG in predicting MetS.

Duodenal Sodium/Glucose Cotransporter 1 Expression Under Fasting Conditions Is Associated With Postload Hyperglycemia.

Type 2 diabetes (T2DM) is associated with a higher intestinal expression of the glucose transporters sodium/glucose cotransporter 1 (SGLT-1) and glucose transporter 2 (GLUT-2). It is currently unsettled whether prediabetes conditions characterized by postprandial hyperglycemia, such as impaired glucose tolerance (IGT) and normal glucose tolerance (NGT) with 1-hour postload glucose ≥155 mg/dL (8.6 mmol/L) (NGT-1h-high) are associated with increased expression of these glucose carriers in the intestine. We evaluated whether duodenal abundance of SGLT-1 and GLUT-2 is augmented in subjects with IGT and NGT-1h-high, in comparison with subjects with NGT and 1-hour postload glucose ˂155 mg/dL (NGT-1h-low). Cross-sectional. A total of 54 individuals underwent an upper gastrointestinal endoscopy. Duodenal SGLT-1 and GLUT-2 protein and messenger RNA levels were assessed by Western blot and reverse transcription polymerase chain reaction, respectively. Of the 54 subjects examined, 18 had NGT-1h-low, 12 had NGT-1h-high, 12 had IGT, and 12 had T2DM. Duodenal SGLT-1 protein and messenger RNA levels were significantly higher in individuals with NGT-1h-high, IGT, or T2DM in comparison with NGT-1h-low subjects. GLUT-2 abundance was higher in individuals with T2DM in comparison with NGT-1h-low subjects; no substantial increase in GLUT-2 expression was observed in NGT-1h-high or IGT individuals. Univariate correlations showed that duodenal SGLT-1 abundance was positively correlated with 1-hour postload plasma glucose levels (r = 0.44; P = 0.003) but not with fasting or 2-hour postload glucose levels. Duodenal SGLT-1 expression is increased in individuals with 1-hour postload hyperglycemia or IGT, as well as in subjects with T2DM, and it positively correlates with early postload glucose excursion.

Role of prediabetes in stroke.

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

Epidemiology of Diabetes and Risk of Dementia

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

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

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

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

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

Association of hemoglobin A1c and glycated albumin with carotid atherosclerosis in community-dwelling Japanese subjects: the Hisayama Study.

BackgroundIt is not clear which glucose measure is more useful in the assessment of atherosclerosis. We investigated the associations of hemoglobin A1c (HbA1c), glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), fasting plasma glucose (FPG), and 2-hour postload glucose (PG) with carotid intima-media thickness (IMT) in community-dwelling Japanese subjects.MethodsA total of 2702 subjects aged 40–79 years underwent a 75-g oral glucose tolerance test and measurements of HbA1c, GA, 1,5-AG, and carotid IMT by ultrasonography in 2007–2008. Carotid wall thickening was defined as a maximum IMT of >1.0 mm. The crude and multivariable-adjusted linear and logistic regression models were used to analyze cross-sectional associations between levels of glycemic measures and carotid IMT.ResultsThe crude average of the maximum IMT increased significantly with rising quartiles of HbA1c, GA, FPG, and 2-hour PG levels in subjects with and without glucose intolerance (GI), while no clear association was observed for 1,5-AG. After adjustment for other confounding factors, positive trends for HbA1c, GA, and FPG (all p for trend < 0.05), but not 2-hour PG (p = 0.07) remained robust in subjects with GI, but no such associations were found in those without GI. When estimating multivariable-adjusted β values for the associations of 1 SD change in glycemic measures with the maximum IMT in subjects with GI, the magnitude of the influence of HbA1c (β = 0.021), GA (β = 0.024), and FPG (β = 0.024) was larger than that of 2-hour PG (β = 0.014) and 1,5-AG (β = 0.003). The multivariable-adjusted odds ratios for the presence of carotid wall thickening increased significantly with elevating HbA1c, GA, and FPG levels only in subjects with GI (all p for trend < 0.001). Among subjects with GI, the area under the receiver operating characteristic curve significantly increased by adding HbA1c (p = 0.04) or GA (p = 0.04), but not 1,5-AG, FPG, or 2-hour PG, to the model including other cardiovascular risk factors.ConclusionsIn community-dwelling Japanese subjects with GI, elevated HbA1c, GA, and FPG levels were significantly associated with increased carotid IMT, and HbA1c and GA provided superior discrimination for carotid wall thickening compared to 1,5-AG, FPG, and 2-hour PG, suggesting that HbA1c and GA are useful for assessing carotid atherosclerosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-015-0247-7) contains supplementary material, which is available to authorized users.

Newly-Diagnosed Disturbed Glucose Metabolism is Associated with Atherosclerosis in Patients with Transient Ischemic Attack or Ischemic Stroke

Objective: Newly-diagnosed disturbed glucose metabolism is highly prevalent in non-diabetic patients with transient ischemic attack (TIA) or ischemic stroke, and increases the risk of recurrent stroke. Diabetes mellitus is associated with atherosclerosis. We aimed to assess whether newly-diagnosed disturbed glucose metabolism is associated with atherosclerosis as well. Research design and methods: Patients with a recent TIA or ischemic stroke were classified in three groups based on glucose levels and use of antidiabetic drugs. Pre-existent diabetes mellitus was defined as the use of antidiabetic drugs prior to the event. Newly-diagnosed disturbed glucose metabolism was defined as two or more disturbed glucose tests: fasting plasma glucose level ≥ 5.6 mmol/L, 2-hour post-load glucose level ≥ 7.8 mmol/L, and/or glycosylated hemoglobin level ≥ 39 mmol/mol. We used CT-angiography to assess stenosis in the carotid artery bifurcations and calcification volume in the aortic arch, carotid bifurcations and intracranial carotid arteries. The relation between glucose groups and measures of atherosclerosis was expressed as odds ratios and beta coefficients with corresponding 95% CI, adjusted for potential confounders. Results: Of the 1217 patients, 384 (32%) had newly-diagnosed disturbed glucose metabolism, and 210 (17%) had pre-existent diabetes mellitus. Newly-diagnosed disturbed glucose metabolism was independently associated with stenosis ≥ 50% (aOR (95%CI) 1.15 (1.04-2.20)). Pre-existent diabetes mellitus was associated with stenosis ≥ 50% and with calcification volume in all regions, especially in patients without the use of cholesterol-lowering drugs prior to the event. Conclusions: Our study shows that newly-diagnosed disturbed glucose metabolism in patients with a recent TIA or ischemic stroke is associated with more severe extra- and intracranial atherosclerosis, similar to pre-existent diabetes mellitus.

Occurrence and Predictors of Persistent Impaired Glucose Tolerance After Acute Ischemic Stroke or Transient Ischemic Attack

Impaired glucose tolerance is often present in patients with a transient ischemic attack (TIA) or ischemic stroke and doubles the risk of recurrent stroke. This impaired glucose tolerance can be transient, reflecting an acute stress response, orpersistent, representing undiagnosed impaired glucose metabolism possibly requiring treatment. We aimed to assess the occurrence of persistent impaired glucose tolerance after a stroke or TIA and to develop a prediction model to identify patients at risk of persistent impaired glucose tolerance. Patients admitted to the stroke unit or TIA clinic of the Erasmus Medical Center with ischemic stroke or TIA and impaired glucose tolerance (2-hour postload glucose level of 7.8-11.0mmol/L) were consecutively enrolled between July 2009 and June 2012. The oral glucose tolerance test was repeated after 3months and patients were classified as having transient impaired glucose tolerance or persistent impaired glucose tolerance. We developed a prediction model by means of a multivariable logistic regression model. We calculated the area under the receiver operating characteristic curve (AUC) to quantify the performance of the model and the internal validity by bootstrapping. Of the 101 patients included, 53 (52%) had persistent impaired glucose tolerance or progression to diabetes. These patients were older and more often had hypertension and used statins. A prediction model including age, current smoking, statin use, triglyceride, hypertension, previous ischemic cardiovascular disease, body mass index, and fasting plasma glucose accurately predicted persistent impaired glucose tolerance (bootstrapped AUC, .777), with statin use, triglyceride, and fasting plasma glucose as the most important predictors. Half of the patients with impaired glucose tolerance after a TIA or ischemic stroke have persistent impaired glucose tolerance. We provide a prediction model to identify patients at risk of persistent impaired glucose tolerance, with statin use, triglyceride, and fasting plasma glucose as the most important predictors, which after external validation might be used to optimize secondary prevention.

BMI and waist circumference are associated with impaired glucose metabolism and type 2 diabetes in normal weight Chinese adults

AimsTo examine the associations of BMI and waist circumference with glucose metabolism and (pre)diabetes among adults with BMI<25kg/m2. MethodsWe conducted a cross-sectional study in a nationally representative sample (10,098 men and 17,454 women) of Chinese adults aged ≥20years with BMI<25kg/m2. Glucose levels after at least 10hours of overnight fasting, at 30minutes and at 120minutes after a standard 75-g oral glucose load were measured. Associations of BMI and waist circumference with outcomes were examined by general linear models for continuous outcomes and by logistic regression models for dichotomous outcomes. ResultsAmong those with BMI<25kg/m2, 18.8% of men and 17.1% of women had abnormal glucose metabolism, including 4.9% of men and 3.8% of women with undiagnosed type 2 diabetes. For each SD increase in BMI (2.1kg/m2) and waist circumference (8.3cm), fasting glucose levels increased by 0.128 and 0.170mmol/L in men, and by 0.112 and 0.167mmol/L in women, respectively; the corresponding increases for 2-hour post-load glucose levels were 0.121 and 0.217mmol/L in men, and 0.241 and 0.362mmol/L in women. When simultaneously included in the same model, these associations with waist circumference were stronger than with BMI. ConclusionObesity measures are associated with abnormal glucose metabolism and diabetes, with central obesity playing a more prominent role than general obesity in Chinese population with BMI<25kg/m2. Chinese diabetes prevention and treatment programs should incorporate targeting of normal weight adults with central obesity.

Prevalence of Prediabetes and Newly Diagnosed Diabetes in Patients with a Transient Ischemic Attack or Stroke

Background: Patients with a transient ischemic attack (TIA) or stroke and prediabetes or newly diagnosed diabetes are at high risk of recurrent stroke or cardiovascular events. This underlines the importance of accurate screening for impaired glucose metabolism in clinical practice. Fasting plasma glucose levels are currently the most commonly measured glycemic parameter to detect prediabetes or diabetes, even if 2-hour postload glucose and glycosylated hemoglobin levels can be used as well. We assessed the prevalence of prediabetes and newly diagnosed diabetes with different screening methods, including fasting plasma glucose, 2-hour postload glucose and glycosylated hemoglobin levels in consecutive patients with recent TIA, ischemic stroke or intracerebral hemorrhage admitted to the stroke unit or visiting the specialized TIA outpatient clinic in the Erasmus Medical Center, Rotterdam, The Netherlands. Methods: We measured fasting plasma glucose, 2-hour postload glucose and glycosylated hemoglobin levels in 269 patients with a TIA, 374 with ischemic stroke and 57 with intracerebral hemorrhage, all without a history of diabetes mellitus. Prediabetes was defined as fasting plasma glucose levels of 5.6-6.9 mmol/l and/or 2-hour postload glucose levels of 7.8-11.0 mmol/l and/or glycosylated hemoglobin levels of 5.7-6.4%. Newly diagnosed diabetes was defined as fasting plasma glucose levels of ≥7.0 mmol/l and/or 2-hour postload levels of ≥11.1 mmol/l and/or glycosylated hemoglobin levels of ≥6.5%. The diagnosis was based on a one-time measurement. Results: Based on fasting plasma glucose, 2-hour postload glucose and glycosylated hemoglobin levels combined, 365 patients (52%) were identified as prediabetics and 188 (27%) as having newly diagnosed diabetes. Patients with intracerebral hemorrhage had more often newly diagnosed diabetes compared with patients with an ischemic stroke or a TIA [27 (47%) and 161 (25%), respectively; p < 0.001]; the prevalence of prediabetes was similar. Newly diagnosed diabetes was identified more frequently by 2-hour postload glucose levels (n = 162; 23%) than by fasting plasma glucose (n = 49; 7%) or glycosylated hemoglobin levels (n = 36; 5%). About one third of the patients with normal fasting glucose levels has impaired glucose tolerance or elevated glycosylated hemoglobin levels. Conclusions: Prediabetes and newly diagnosed diabetes are highly prevalent in patients with a TIA or stroke. The majority of these patients would not have been identified by fasting plasma glucose levels alone. Both 2-hour postload glucose and glycosylated hemoglobin levels identify more patients with a disturbed glucose metabolism.

Safety and FeasibiLity of Metformin in Patients with Impaired Glucose Tolerance and a Recent TIA or Minor Ischemic Stroke (LIMIT) Trial – A Multicenter, Randomized, Open-Label Phase II Trial

We aimed to assess the safety, feasibility, and effects on glucose metabolism of treatment with metformin in patients with TIA or minor ischemic stroke and impaired glucose tolerance. We performed a multicenter, randomized, controlled, open-label phase II trial with blinded outcome assessment. Patients with TIA or minor ischemic stroke in the previous six months and impaired glucose tolerance (2-hour post-load glucose levels of 7.8-11.0 mmol/l) were randomized to metformin, in a daily dose of 2 g, or no metformin, for three months. Primary outcome measures were safety and feasibility of metformin, and the adjusted difference in 2-hour post-load glucose levels at three months. This trial is registered as an International Standard Randomized Controlled Trial Number 54960762. Forty patients were enrolled; 19 patients were randomly assigned metformin. Nine patients in the metformin group had side effects, mostly gastrointestinal, leading to permanent discontinuation in four patients after 3-10 weeks. Treatment with metformin was associated with a significant reduction in 2-hour post-load glucose levels of 0·97 mmol/l (95% CI 0·11-1·83) in the on-treatment analysis, but not in the intention-to-treat analysis (0·71 mmol/l; 95% CI -0·36 to 1·78). Treatment with metformin in patients with TIA or minor ischemic stroke and impaired glucose tolerance is safe, but leads to minor side effects. If tolerated, it may lead to a significant reduction in post-load glucose levels. This suggests that the role of metformin as potential therapeutic agent for secondary stroke prevention should be further explored.